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NA VMED P-5088
i UNITED STATES NATV^^
I Medical News Letter
Friday, 16 April 1965
Portrait of RADM E. C. KENNEY
What's New in the Management of Trauma I
Tagged Specimens Aid Biotracking Studies 2
Glaucoma, Tonometry and Visual Field Testing 4
Letter to RADM Kenney 6
FROM THE NOTE BOOK
Urgent Training Notice 7
MSC Officers Graduate 7
ATTEN : Hospital Corpsmen and Dental Technicians 8
Change of Title of MSC Section 8
Model Ordinance Regulating Ambulance Service 8
RADM McDonald Reelected President of Navy
Mutual Aid Association 8
Mass Application of Stannous Fluoride Cariostasis in
Naval Personnel 9
Clinical Significance of Dehiscence and Fenestrations 1 2
Smoking and Cancer of the Mouth, Pharynx and
An Improved Self-Curing Acrylic Restoration 14
Know Your Dental Corps
Personnel and Professional Notes
Influenza and Influenza-Like Illness
Rubella in Contacts of Infants with Rubella-Asso-
Declaration of Helsinki
Antimicrobial Prophylaxis for Individuals with a
History of Rheumatic Fever
Know Your World
Aerospace Medical Association
LT Richard R. Shultz Receives Award
Procurement, Training, and Assignment of Pharmacy
Changes in Army PG Courses
Annual Anesthesiology Review Session for the
LCOL B. S. Ott Receives Award
■ 1— I
United States Navy
MEDICAL NEWS LETTER
Friday, 16 April 1965
Rear Admiral Robert B. Brown MC USN
Rear Admiral R. O. Canada MC USN
Deputy Surgeon General
Captain M. W. Arnold MC USN (Ret), Editor
William A. Kline, Managing Editor
Aviation Medicine Captain C, E. Wilbur MC USN
Dental Section Captain C. A. Ostrom DC USN
Occupational Medicine CDR N. E. Rosenwinkel MC USN
Preventive Medicine Captain J. W. Millar MC USN
Radiation Medicine CDR J. H. Schulte MC USN
Reserve Section Captain C. Cummings MC USNR
Submarine Medicine CDR J. H. Schulte MC USN
The U.S. Navy Medical News Letter is basically an
official Medical Department publication inviting the
attention of officers of the Medical Department of the
Regular Navy and Naval Reserve to timely up-to-date
items of official and professional interest relative to
medicine, dentistry, and allied sciences. The amount
of information used is only that necessary to inform
adequately officers of the Medical Department of the
existence and source of such information. The items
used are neither intended to be, nor are they, sus-
ceptible to use by any officer as a substitute for any
item or article in its original form. All readers of the
News Letter are urged to obtain the original of those
items of particular interest to the individual.
Change of Address
Please forward changes of address for the News Letter
to: Commanding Officer, U.S. Naval Medical School,
National Naval Medical Center, Bethesda, Maryland
20014, giving full name, rank, corps, and old and new
FRONT COVER: The U.S. Naval Hospital, Corpus Christi, Texas (Official U.S. Navy Photograph) was
commissioned on 1 July 1941 and at that time had accommodations for 545 beds.
Located eleven miles from downtown Corpus Christi this hospital occupies 65.8 acres of land within the
confines of the U.S. Naval Air Station.
During Fiscal Year 1964, there were 3,286 admissions, to the hospital and some 55,000 outpatient visits.
The pharmacy Service filled approximately 122,000 prescriptions. Laboratory procedures performed totaled
81,027 tests. Radiological Service technicians made 45,255 x-rays and 1,066 fluoroscopic examinations.
Births totaled 55 1 for the year.
On 1 February 1964 a Regional Data Processing Center was activated and now includes: patient statistical
data, workload data, stocking level data for supplies and cost accounting for Food Service. — Editor.
The issuance of this publication approved by the Secretary of the Navy on 4 May 1964.
U.S. NAVY MEDICAL NEWS LETTER
WHAT'S NEW IN THE MANAGEMENT OF TRAUMA'
CAPT B. Eiseman, MC USNR, Professor and Chairman, Department of Surgery,
University of Kentucky Medical School, Lexington, Kentucky,
The management of battle casualties is the single
most important professional duty that distinguishes
the medical corps of the armed services from their
civilian professional colleagues. In times of peace this
fact is often neglected. The disastrous medical exper-
iences so common in the opening months of very
new armed conflict attest to this senseless historical
repetition. This problem and challenge now is more
significant than ever before, for the conscientious
medical officer must not only remember what was
standard procedure for treatment of the wounded
one-conflict ago, but also must try to remain current
with the voluminous surgical and research literature.
General medical officers or specialists in fields other
than surgery cannot hope to remain intelligently cri-
tical of the latest suggestions for the management
of the injured.
In subsequent issues of this periodical various
civilian authorities (many of them reservists) will
be asked to review in a brief and critical manner
the current status of a new or controversial subject
pertaining to the treatment of the injured. The re-
views will be personal evaluations of the field in
which the author is expert. They will provide a few
key references but in the main will aim to provide
a concise statement concerning a new method of
casualty management; the physiologic background
for its use; a critical evaluation of the laboratory
and clinical data supporting its employment; and fin-
ally, a personal evaluation by the author of the role
this new therapeutic modality might play in the fu-
ture management of the injured.
LOW MOLECULAR WEIGHT DEXTRAN
As a plasma volume expander, dextran is well
known to physicians caring for the injured. The dex-
tran which has been clinically available for the past
* First of the new series of articles announced in the Newsletter
Vol. 45, No. 6 of 26 March 1965.
decade (the so-called Swedish- American clinical
dextran) has an average molecular weight of 75,000.
Its plasma volume expanding effect results from its
oncotic activity. Chemically, dextran is a long chain
glucose polymer produced by the action of a bacte-
rium, Leuconostoc mesenteroides, on sucrose. The
crude dextran so produced ishydrolyzed, purified and
fractionated to a particular molecular weight range.
Following World War II Gronwall and Ingelman
noted that dextran fractions of high molecular
weight caused an increase in erythrocyte sedimenta-
tion rate and an increase in red cell aggregation
in dogs. Later, Thorsen and Hint found that dex-
trans below 59,000 molecular weight were capable
of reversing such aggregation. Knisely had noted a
similar phenomenon, which he termed sludging, to
occur in the microcirculation of animals following
various types of injury. Recently, Hardaway has em-
phasized the role these cellular aggregates (as mi-
crothrombi) might play in the pathogenesis of
shock. He and others have recently directed attention
to the importance of tissue perfusion at the cellular
level in the etiology of shock.
Following the observation that erythrocyte aggre-
gation occurs after many types of bodily insult and
that such aggregates could be prevented or reversed
by the addition of the lower molecular weight frac-
tions of dextran, there was interest in the use of
such an agent in various clinical situations where
an increase in tissue perfusion was required. A com-
mercial laboratory in Uppsala Sweden prepared a
10% intravenous infusion solution of dextran having
an average molecular weight of 40,000 with 90%
of the fractions being in the range of 10,000 to
80,000. It is dissolved in either normal saline or
in 5% dextrose in water.**
Dextran-40,000, like the earlier clinical dextran
(dextran-75,000), is a hyperoncotic solution
** Rheomacrodex « (dextran-40,000)
U.S. NAVY MEDICAL NEWS LETTER
which acts to draw water into the vascular compart-
ment. The plasma expansion produced by dextran-
40,000 is actually greater that that produced by
dextran-75,000 but, because of the more rapid ren-
al clearance of the smaller molecules, this effect is
of shorter duration. Gelin has noted that 50% of
dextran-40,000 is cleared within 3-5 hours where-
as only 35% of dextran-75,000 is cleared in the
The unique therapeutic properties of dextran-40,-
000 result from its ability to promote blood
flow when such flow is decreased as a consequence
of injury. It asserts such an action in at least two
ways. First, by reason of its oncotic activity it draws
water into the vascular compartment, thus diluting
the suspension of erythrocytes. With a lowered hema-
tocrit there is less resistance to flow. The second
mechanism by which dextran-40,000 lowers vascu-
lar resistance is by its ability to decrease or prevent
erythrocyte aggregation. Following trauma, for re-
sons by no means clear, the erythrocytes and other
formed elements in the blood become sticky. By
counteracting this, dextran-40,000 again reduces
the resistance to flow.
Since 1957 there have been numerous laboratory
and clinical studies of dextran-40,000. It has been
clinically evaluated in various types of shock where
it is intended to increase perfusion of the vital tis-
sues in vascular surgery to prevent the formation
of thrombi with small vessel grafts or protheses in
the heart-lung machine to prevent the formation of
red cell aggregates which impede flow as well as
to diminish the destruction of platelets which occurs
during use of the pump, in cold injury, organ perfu-
sion, various arterial insufficiencies, and many oth-
ers. Many of the clinical studies have been uncon-
trolled and the therapeutic effects of dextran-40,-
000 have been difficult to evaluate objectively.
In general, the reported studies have been enthu-
siastic but confirmatory data of the superiority of
dextran-40,000 over other available treatment
methods is too seldom seen. In some clinical trials
control infusion of dextran-75,000, 5% dextrose
in water and normal saline should be employed.
Unlike dextran-75,000 the low molecular weight
dextran does not interfere with blood typing or
cross-matching. Also, there is apparently no clini-
cally significant effect on bleeding time so long as
the manufacturers dosage recommendations are
Dextran^l0,000 has not yet been approved by
the Food and Drug Administration and is therefore
available only for investigational use. While the phy-
sician and surgeon should be aware of the unique
properties of this new material, there is still a need
for more controlled evaluations of it to establish its
proper therapeutic usefulness. It is a substance of
potential clinical value but there is insufficient evi-
dence at this time to advocate its general use in
the management of the injured.
WHICH WAY DID THEY GO?—
TAGGED SPECIMENS AID BIOTRACKING STUDIES
Submitted by CDR H. D. Baldridge MSC USN, Naval Medical Research Institute,
Bethesda, Maryland 20014.
The migratory habits and number distribution of
wildlife are best studied by means of observations
on tagged or marked specimens which mingle freely
in nature with others of their kind. Each year biolo-
gists band, tag, or otherwise mark thousands of ani-
mals and release them under controled conditions
at known geographical location. Recapture of these
specimens and the notation of time and location pro-
vides data on ranging distances and speeds. Of inter-
est to the Navy in particular are those tagging pro-
U.S. NAVY MEDICAL NEWS LETTER
grams associated with the fishes and birds of the
sea. It is the purpose of this article to call attention
to two such current programs being conducted in
the realm of the seas and to invite the cooperation
of Navy personnel throughout the world.
It is interesting to note that during the 19th cen-
tury infancy of the science of Marine Biology, medi-
cal department personnel serving aboard ships of
the United States Navy were responsible for gather-
ing much of the data on natural history of the oceans
used by American zoologists of that time. Research
on the ecology and behavior of animals of the sea
continues to welcome and profit from observations
made by the trained eyes of shipboard personnel
of the Navy.
SHARKS — The Shark Research Panel of the Am-
erican Institute of Biological Sciences is currently
conducting an International Shark-Tagging Program
under the sponsorship of the Biology Branch, Biolo-
gical Sciences Division, of the Office of Naval Re-
search. Study of the basic biology of sharks has been
receiving a substantial amount of attention in recent
years, and experimental or laboratory work on
sharks may be expected to bring to light many new
bits of information that will help in understanding
them. But this is not enough. Information is needed
on the distribution habits and on the movements
of sharks in their natural environment. For practical
reasons it is a matter of great interest to learn more
about the larger species.
Probably the best and fastest way to obtain the
kinds of information needed is the tagging and re-
leasing of tagged sharks. If a tagged shark is caught
a second time, information is added to the store
of knowledge about sharks. How much is learned
depends to a great degree upon the quality of the
records that are kept and made available in a data
pool. It has been estimated that about 2500 sharks
of various species were tagged last year in waters
all over the world.
Navy personnel, particularly off-duty crew mem-
bers ashore and afloat who fish for a hobby or pas-
time, might be in a position to provide some of the
most important and informative returns. For the
return of an AIBS tag from a captured shark, along
with the information requested on the tag, the
Shark-Tagging Information Center will forward a
formal certificate of acknowledgement of assistance
along with the standard tag reward of one dollar.
Efforts of the Shark Research Panel tagging pro-
gram have been designed to stimulate interest in
shark tagging and to assist in obtaining returns by
direct communication with individuals, fishing clubs,
and industrial operations likely to be of assistance
in catching tagged sharks. In addition, a bimonthly
newsletter is distributed to publicize tagging activities
and other matters of interest to investigators, cooper-
ators, and fishermen. Assistance is also available to
cooperators in obtaining satisfactory identification of
sharks tagged or recaptured. Tags of standard de-
sign are available to approved applicants, and reason-
able assurance of priority in data publication is ex-
tended to cooperators and investigators.
Requests for information concerning this program
and the availability of tags should be directed to
Stewart Springer International Shark-Tagging Pro-
gram, American Institute of Biological Sciences,
3900 Wisconsin Avenue N.W. Washington, D. C.
SEABIRDS. Hundreds of thousands of far-travel-
ing ocean birds of many kinds are being captured,
marked, and released on mid-Pacific islands in a
widespread study of seabird migration by the Smith-
sonian Institution, Washington, D. C. Although it
is known that some kinds of birds perform remar-
kable annual migrations of 10,000 miles or more
over the North and South Pacific Oceans, the regular
travels of most species are unknown or poorly
To learn more about the migration of seabirds,
Smithsonian ornithologists have captured and
marked over 300,000 birds of 28 different kinds
in the Central Pacific with standard, numbered,
United States Fish and Wildlife Service aluminum
legbands. Of these, over 60,000 have been marked
with 4-inch colored plastic leg-streamers.
Anyone coming into the possession of a banded
dead bird in the Pacific or Indian Ocean areas is
asked to cooperate by returning the band, together
with the time and place of recovery, as instructed on
the band. For live birds, only the band number to-
gether with time and place of capture need be sent
to the directed address, after which the bird should
be liberated so that its further travel may be traced.
Anyone sighting a bird with a colored leg-stream-
er anywhere in the Pacific or Indian Ocean areas
is asked to cooperate by recording the name or des-
cription of the kind of bird wearing the streamer,
the color of the streamer, the date seen, and the
latitude and longitude or approximate location of
the sighting. All information on birds with colored
leg-streamers should be sent as soon as possible to
the Division of Birds, Smithsonian Institution, Wash-
ington, D. C. 20560. Requests for additional infor-
mation concerning the seabird-tagging program
U.S. NAVY MEDICAL NEWS LETTER
should also be directed to this address. In return
for sighting or recovery data, each cooperator will
be advised where the banded or color-marked bird
Navy personnel, particularly those of deployed
operating forces, are in a unique position to gready
aid biotracking programs such as those described
for sharks and seabirds. For this reason, it is asked
that information concerning these programs be circu-
lated widely. A notice in the ship or station news-
paper would surely help to pass the word to local
birdwatchers, beachcombers, and fishermen.
GLAUCOMA, TONOMETRY AND VISUAL FIELD TESTING
Recent changes in the Manual of the Medical
Department impose the requirement for annual ton-
ometric examination of all naval aviators 35 years
of age and over. Since there are numerous hazards
inherent in any glaucoma screening program, an at-
tempt will be made to point up some of the more
obvious ones not mentioned in ManMed.
The Schiotz tonometer applied to the anesthetized
cornea provides a measure of intraocular pressure
relative to the time the measure is taken and the
scleral rigidity factor. Since there are diurnal varia-
tions in pressure and individual differences exist in
adapting to fluid intake, a single measurement of
intraocular pressure is not necessarily indicative of
the presence or absence of glaucoma.
Recent valid studies have demonstrated that the
yield of a glaucoma screening program may be
doubled by performing both a visual field test and
tonometry, as compared to the results obtained with
tonometry alone. In fact, the report emphasized that
"of the 12 with open angle glaucoma, only four had
abnormal Schiotz or applanation pressure reading
on the first examination (screening) and two had
abnormal readings only in the remaining pressure
tests. The remaining six subjects had normal values
in the entire battery of pressure tests on the first
examination, and only on repeated follow-up did
they demonstrate evidence of hypertension. All 12
subjects were detected in the visual field test by the
presence of an arcuate scotoma." 1
Visual field tests recommended for use in conjunc-
tion with tonometry in glaucoma screening programs
include (1) tachistoscopic multiple pattern visual
field screening devices and (2) the tangent screen.
The Federal Supply Catalog, FSC Class 6515 lists
items in both categories: FSN 6515-582-0444, Ta-
chistoscope, Visual Field Testing; and relatively in-
expensive tangent screens, FSN 6515-381-0690
(Folding) or FSN 6515-381-0700 (Roller), Screen,
Tangent, Eye Examining. While the multiple pattern
device provides a gross estimate of the status of
1. Armaly, Mansour F. ( M.D., "Glaucoma Tests; A Population
Study", Sight Saving Review, 32(3), 1962.
the visual field, and requires approximately four
minutes per patient, the tangent screen provides, an
accurate plot of the central field but requires more
time and a trained examiner. Either technique meets
the requirements for visual field screening.
Contrary to the belief of many, the Schiotz tono-
meter is not the only instrument which provides a
measure of intraocular pressure. There are several
applanation type instruments which measure intra-
ocular pressure more accurately and more consistent-
ly than the Schiotz identation type instrument. These
are the electronic applanation type instruments
which measure intraocular pressure more accurately
and more consistently than the Schiotz identation
type instrument. These are the electronic applana-
tion devices (Mackay-Marg, Biotronics, Berkeley
Instrument Co. Instruments), and the mechanical
applanation unit, the Goldmann instrument which
fits either the Haag-Streit or Thorpe Slit Lamps.
In addition to errors inherent in the Schiotz in-
strument, improper use of the tonometer, and scleral
rigidity, another of the hazards of a mass screening
program is the corneal damage inflicted on the unsus-
pecting patient through poor technique. It is recog-
nized that in many instances in the Navy, the test
is accomplished by a hospital corpsman who is often
not under the direct supervision of a professional
examiner. Since optometry officers who are recent
graduates, and other military optometrists who have
attended courses on glaucoma detection have re-
ceived training in the use of the Schiotz tonometer
on the eye, it is suggested that in the absence of
a medical officer who has been trained in the use
of this instrument the optometry officer perform the
An important area which is not covered by
ManMed 15-92 concerns the methods for sterilizing
the tonometer. There are numerous devices on the
market which can be used for maintaining some
semblance of sterility of the tonometer footplate and
plunger tip — the only parts which touch the eye.
The various devices use ultra-violet radiation, heat,
U.S. NAVY MEDICAL NEWS LETTER
or chemicals for sterilization. When ether, alcohol,
or benzalkonium chloride (1:3000) are used, the
instrument must be carefully rinsed with distilled wa-
ter. A commercially available item called "Ton-
ofilm" may be used. This is a latex tip which is
applied over the footplate of the tonometer. Use
of this device is presumed to preclude bacterial con-
tamination of the cornea by the tonometer. "Ton-
ofilm" is a rather expensive item — $.25 each in
package of 100.
In summary: (1) for maximum yield, a glaucoma
screening program should include both visual field
testing and tonometry (2) testing should be per-
formed only by trained professional (3) Tonometry
may be accomplished with any of several devices
available (4) visual field tests may be performed
using a tangent screen or a multiple pattern field
testing device (5) tonometers must be kept clean,
sterilized and in adjustment.
—Optometry, Code 3121, BUMED.
RHEUMATIC FEVER CONCEPTS
In persons susceptible to rheumatic fever, massive
monthly injections of penicillin, rather than small
daily doses, do a better job in preventing streptococ-
cal throat infections, and sulfadiazine pills are as
effective as the more expensive penicillin. The extent
of permanent heart change does not depend on the
number of rhumatic fever attacks; if damage is go-
ing to occur, it will be as a result of the first attack.
Absence of a sore throat does not mean there is no
"strep" infection; nor does the presence of one ne-
cessarily indicate "strep" infection.
These findings which refute some generally ac-
cepted concepts, resulted from a 10-year study con-
ducted by Irvington House, a New York City volun-
tary agency (reported in a 1964 supplement to An-
nals of Internal Medicine). — Public Health Reports
80(1): 10, January 1965.
S. C. CAMPAIGN ON DISEASE
The County of Greenville, S. C, seeks to immun-
ize all its citizens agaist poliomyelitis, DPT, and
smallpox. It hopes to establish a program whereby
each county resident will begin immunizations at the
age of 6 to 8 weeks, complete them on schedule,
and maintain them throughout life. Residents will
be encouraged to make up immunizations they have
As part of an investigation of a widespread fungus
infection that caused 40 cases of erythema multi-
forme in the town of Greenwood, S. C, the Public
Health Service gave high school and junior high
school students skin tests. Erythema multiforme, a
rare disease, is believed related to histoplasmosis. —
Public Health Reports 80(1): 10, January 1965.
CLEFT PALATE CLINICAL RESEARCH CENTER
The largest clinical research center in the United
States for the study of cleft lip and palate will be
established at the Lancaster Cleft Palate Clinic, Lan-
caster, Pa., under a grant from the Public Health
Service's National Institute of Dental Research.
Dr. Herbert K. Cooper, founder and director of
the Lancaster Clinic, will conduct the comprehensive
research program, studying the oral birth defect
from its origin to its treatment. He will head a team
which will probe factors that may cause cleft palate
and cleft lip, evaluate surgical and dental procedures
to correct the deformity and habilitate speech, and
test the psychological effects on patients and their
families.— Public Health Reports 80(1): 59, Jan-
PHYSICAL EXERCISE FOR HEART PATIENTS
A research project at Donolo Institute of Physiolo-
gical Hygiene in Jaffa, Israel, backed by the Voca-
tional Rehabilitation Administration, Department of
Health, Education, and Welfare, seeks to get heart
patients back on the job by having them engage
in physical exercise.
Daniel Brunner M. D., its director, says that sur-
veys in Israel have indicated that incidence of heart
attacks in sedentary workers was three times greater
than among nonsedentary groups subjected to simi-
lar diets and living conditions on an Israeli kibbutz,
or communal farm. Followup studies, he says, show
that ex-patients in hard-labor jobs had a greater sur-
vival rate then those who were sedentary after their
Researchers in the present project are doing lar-
ger-scale followup to buttress earlier findings. In ad-
dition the project is developing a course of gradual-
physical training for about 100 heart patients, first
with exercises and subsequently with sports.
Mary E. Switzer, U. S. Commissioner of Voca-
tional Rehabilitation, comments that "This project
like many others the Vocational Rehabilitation Ad-
ministration is backing in nine foreign countries, is
a good example of how VRA can work to benefit
the people of foreign lands, while, at the same time,
gaining insight into problems which are of the ut-
most importance in rehabilitation work here at
home." — Public Health Reports 80(1) : 46, January
U.S. NAVY MEDICAL NEWS LETTER
U.S. NAVAL HOSPITAL
Fleet Post Office
San Francisco, California 96662
15 February 1965
Rear Admiral E. C. Kenney MC USN
Bureau of Medicine & Surgery
Department of the Navy
Washington 25, D. C.
Dear Admiral Kenney:
On 12 March 1965, the U. S. Naval Hospital, Yokosuka, Japan, will hold com-
mencement exercises for the sixteen Japanese interns who will have successfully
completed their year of internship training on that date. These young physicians
were specifically recommended by the Dean and the leading professors of their
medical school. Thereafter, they were representatives of the 42 successful candi-
dates for the Tri-Service Internship offered in Japan. They thus represent the
most qualified of all Japanese medical students. They have not been found wanting
in their year of training. It has been most gratifying to observe their professional
advancement during this year. Twelve of sixteen interns have received permanent
certification by the Educational Council for the Foreign Medical Graduates; the
others, we predict, will be successful in a repeat examination this fall. We have
also learned from them some of the interesting social and cultural customs of the
Japanese, thus contributing to a very effective People-to-People Program.
It is with pleasure that I commend their action to you,
S/E. P. IRONS
CAPT MC USN
U.S. NAVY MEDICAL NEWS LETTER
FROM THE NOTE BOOK
URGENT TRAINING NOTICE
APPLICATIONS FOR INSERVICE
RESIDENCY TRAINING 1966-1967
Interested applicants for inservice residency train-
ing, should carefully review BUMEDINST
1520. IOC for information concerning programs
offered and procedure for submitting applications.
Deadline for submission of inservice and outser-
vice training programs to begin in the summer and
fall of 1966 is 1 July 1965. Candidates will be no-
tified of selection or nonselection as soon thereafter
as possible. Applications, submitted via chain of
command, should be for the full training program
as outlined in BUMEDINST 1520.10C.
Combined programs, such as in Neurosurgery,
should be requested for the inservice portion first
to begin in the summer of 1966, with the civilian
portion to follow in a civilian institution to be
Applicants are encouraged to list at least three
choices of naval hospitals for location of training
if such choices exist in the chosen specialty, and
may feel free to write the chiefs of services for
details of the training offered, if desired.
Early submission of applications is recommended
to assure processing through chain of command and
receipt in BuMed prior to the 1 July 1965 deadline.
—Training Branch, BUMED.
MSC OFFICERS GRADUATE
Sixteen Medical Service Corps officers were a-
mong The George Washington University graduates
at the Winter Convocation in Constitution Hall,
Washington, D. C, on 22 February 1965. These
officers earned their degree primarily as a result of
their efforts through participation in part-time, off-
duty courses of instruction. In several cases however,
the degree was earned as a result of a cooperative
program authorized by BuMed in August 1960 with
The George Washington University that provided for
the establishment of an off-campus center of The
College of General Studies at the U.S. Naval School
of Hospital Administration, Bethesda, Maryland.
Since that time, 142 Medical Service Corps officers
have graduated from that course and more than 80%
of those officers have completed, or are working to-
ward, their degree.
The following officers were awarded degrees as
Master of Arts — Personnel Administration
LT Lewis E. Angelo BUMED (Code 3142)
Master of Arts — Financial Management
LCDR Alan D. Bauerschmidt NNMC
Bachelor of Arts — General
*LCDR Alan D. Bauerschmidt
LT Ronald R. Bolton
*LT Donald E. Brouillette, Sr.
*LT Joseph D. Cicero
LT Max Leon Cooper
LT Bruce J. Dietz
LTJG Emile N. Giard
LT James H. Herrin
*LT Kenneth F. Hines
*LT Howard D. Madison
*LT Joseph R. Mulvey
*LT Jack A. Nelson
LT Langston E. Richardson
* Degree awarded 30 September 1964.
BUMED (Code 482)
BUMED (Code 13)
PG School, Monterey
PG School, Monterey
U.S. NAVY MEDICAL NEWS LETTER
Bachelor of Arts — Business Administration
LT William J. Auton
LT Charles R. Mountain
All Medical Service Corps officers are urged to
pursue their education which will be sponsored by
BuMed under the provisions of BuMed Instruction
150O.7A, These officers should also familiarize them-
selves with BuMed Instruction 1520.12B which out-
lines the Bureau's policy in making selections for
assignment to full-time duty under instruction.
The above listed officers are commended for their
academic achievement, and deserve a traditional
Navy "well done" for their accomplishments.
—Code 35, BUMED.
ATTENTION: HOSPITAL CORPSMEN
AND DENTAL TECHNICIANS
Hospital Corpsmen and Dental Technicians who
took the Officer Selection Battery Tests for the FY
66 Medical Service Corps in-service procurement
program outlined in BUPERSINST 1520.15F, may
obtain the result of their scores by submitting a re-
quest to the Chief of the Bureau of Naval Personnel
(ATTN: Pers B-623).
CHANGE OF TITLE OF MSC SECTION
The Secretary of the Navy recently approved a
change in the title of the WOMEN'S Specialist Sec-
tion of the Medical Service Corps to the Medical
Specialist Section. This change will allow the ap-
pointment of qualified male physical therapists, oc-
cupational therapists and dietitians in the Navy
Medical Service Corps. Heretofore, appointments in
these specialties have been restricted to women. To
further enhance recruiting efforts for dietitians, the
Navy will now sponsor qualified dietetic students
during their final 24 months of professional training,
including a dietetic internship. It is believed that
the above changes will result in an increase in the
number of physical therapists, occupational thera-
pists, and dietitians appointed, and will permit more
realistic staffing in naval hospitals for these special-
ties. — Medical Service Corps Division, BUMED.
MODEL ORDINANCE REGULATING
The Division of Accident Prevention of the Public
Health Service, USDHEW, has reproduced "A Mo-
del Ordinance Regulating Ambulance Service" for
distribution to State and local health authorities to
AdCom, Great Lakes
promote uniformity and to improve local emergency
medical services and facilities throughout the United
The ordinance was developed by the Joint Action
Program of the American College of Surgeons, the
American Association for the Surgery of Trauma,
and the National Safety Council. This model act
covers the regulation of licensing, inspection and
operation of ambulances, and sets standards or the
licensing of ambulances and of ambulance drivers,
attendants and attendant-drivers.
In working cooperatively with the members of the
Joint Action Program, ambulance and rescue asso-
ciations, and other groups concerned, the Public
Health Service has been sponsoring Emergency Medi-
cal Services studies, surveys and training programs.
The ultimate goal of all the participating groups
is to assure the American public of the best possible
emergency medical care for the injured and critically
Copies of the model ordinance may be obtained
by writing to the Chief, Emergency Medical Servi-
ces, Division of Accident Prevention, Public Health
Service, U. S. Department of Health, Education, and
Welfare, Washington, D. C. 20201. (PHS, DHEW
News Release, 20 Feb 1965.)
ADMIRAL McDONALD REELECTED
PRESIDENT OF NAVY MUTUAL AID
The Board of Directors of the Navy Mutual Aid
Association at their Annual Meeting on 19 Feb-
ruary 1965 announced the reelection of Admiral
David L. McDonald USN, as President. Other offi-
cers elected by the membership were Rear Admiral
A. H. Van Keuren USN (Ret.), First Vice President;
Vice Admiral V. R. Murphy USN (Ret), Second
Vice President; Lieutenant General C. H. Hayes
USMC third Vice President; Vice Admiral K. K.
Cowart, USCG (Ret), Fourth Vice President; and
Captain P. R. Engle MC USN, Vice President-
Elected to the Board of Directors were:
Rear Admiral L. A. Bachman USN (Ret)
Admiral Arleigh Burke USN (Ret)
Rear Admiral J. O. Cobb USN
Rear Admiral P. Corradi CEC USN
U.S. NAVY MEDICAL NEWS LETTER
Rear Admiral J. W. Crumpacker SC USN
Rear Admiral J. B. Heffeman USN (Ret)
Captain J. W, Higgins Jr. USN
Rear Admiral W. I. Martin USN
Rear Admiral R. L. Moore Jr. USN
Captain G. D. O'Brien USNR
Captain W. H. Schleef SC USN
Rear Admiral A. M. Stiinn USN
Brigadier General J. L. Stewart USMC
The Board of Directors reappointed Captain T. M.
Davis USN (Ret), as Secretary and Treasurer, and
Lieutenant Commander M. E. Koepke MSC USN
(Ret) as Assistant Secretary and Treasurer.
Vice Admiral V. R. Murphy, USN, Ret., was con-
tinued in office as Chairman of the Finance Commit-
tee; Vice Admiral K. K. Cowart, USCG, Ret., as
Chairman of the Membership Committee; and, Rear
Admiral L. A. Bachman, USN, Ret., as Chairman
of the By -Laws Committee.
The Cha?e Manhattan Bank of New York was
continued as investment counsel for the Association
and the Morgan Guaranty Trust Company of New
York retains custody of the Association's securities.
The actuarial firm of Bowles, Andrews & Towne of
Richmond, Virginia, will continue to serve as the
Association's actuarial advisor.
Captain Davis reported that in 1964, the total
death benefit for Regular members was increased
from $10,000 to $11,000 at no increase in cost.
Also, an additional death benefit was established for
Junior members at the Coast Guard and Naval
Academies, making that total death benefit $10,000
without an increase in cost. Navy Mutual Aid mem-
bership at the end of 1964 exceeded 44,000 and
the Association's assets exceeded $76,000,000.
MASS APPLICATION OF STANNOUS FLUORIDE
CARIOSTASIS IN NAVAL PERSONNEL
RADM Frank M. Kyes, DC USN*, Bureau of Medicine and Surgery, Navy De-
partment, Washington, D.C.
Legendary Gordius, king of ancient Phrygia, tied
an exceedingly complicated knot on the yoke of
his chariot. The oracles said that the man who
loosed that knot would go on to rule all Asia. This
was accomplished by Alexander the Great who
CUT the knot with his sword. Thus developed the
term "Gordian knot" — a difficulty which can be
overcome only by bold strokes. I believe that a few
bold strokes applied now will solve our dilemma
in Armed Forces dentistry within a few years. There
are three steps we must take: two of them are in
the face of cherished tradition; and the third is to
conduct the research, development, test and evalua-
tion necessary to develop an effective system for
annual application of stannous fluoride in three
* Presented by the Assistant Chief of the Bureau of Medicine and
Surgery (Dentistry), and Chief of the Dental Division, before the
Dental Section at the 7lst Annual Meeting of the Association ot
Military Surgeons of the U.S., Washington D.C, 20-22 October,
agents in all Armed Forces personnel.
The first step was initiated ten years ago and pro-
ven valid in the limited population of the U. S. Naval
Academy. The second step was initiated six years
ago in the recruit population at the U.S. Naval
Training Center, Great Lakes; and to date it has
limited acceptance in the Naval Dental Corps. The
third step is in an active problem of research, devel-
opment, test and evaluation in seven selected naval
PREFERENTIAL TREATMENT OF EARLY
The U.S. Naval Academy, with approximately
4,000 members in the Brigade of Midshipmen, and
an amply staffed dental department, presents an ex-
citing story on the effect of a deliberate program
of preferential treatment of early caries lesions.
U.S. NAVY MEDICAL NEWS LETTER
Ten years ago, because of circumstances beyond
the control of the dental department, dentistry at
the Naval Academy temporarily became, as the Su-
perintendent expressed it, "A crash program on the
first class" — meaning the graduating seniors. It was
indeed that. As one strode through the clinic, the
effects of delayed treatment during the preceding
three years was apparent at a glance. Extractions
and pulp-cappings were frequent. Most of the cavi-
ties restored were both deep and large. The sick
call each morning, consisting of patients suffering
pain, frequently ran over a score and presented a
daily administrative and professional problem. Be-
cause of the concentration on completing the dental
treatment needs of the first class before graduation,
little time was left for routine treatment of the three
lower classes. It was recognized that this concentra-
tion on the first class was self-defeating in that the
delay in treatment of the junior classes would permit
their dental needs to progress to the same advanced
stage as that of the first class.
Ten years ago, it was decided to reverse this situa-
tion. Emphasis on completion of dental treatment
was placed first on the fourth class; and any addi-
tional capability of the dental department was then
given to the more advanced classes, even to the ex-
tent, if necessary, of letting some seniors graduate
with uncompleted work.
In less than two years, this bore fruit. Preferential
treatment of minimal lesions proved so effective that
all operative dentistry was accomplished in each
class, and all in the form of smaller restorations.
More teeth were restored. There were fewer extrac-
tions and fewer pulp-cappings. The benefit was
also obtained in the dental officer distribution. In
a ten-year transition, we have been able to reduce
the total number of dental officers, to add the capa-
bility of a periodontist and an orthodontist, and to
reduce the number of officers assigned to operative
dentistry from 12 to 8.
THE CEMENT ALLOY PROGRAM
Preferential treatment of early lesions was rela-
tively easy at the Naval Academy because it was
limited to only 4,000 men whom we had available at
the same place for four years. This principle could
not be applied to a Navy of 850,000 men, of which
125,000 are recruits each year and who, after only
nine weeks of recruit training, go on to duty in
unpredictable ships and stations.
In the beginning of this paper, I said that there
were three distinct steps toward an effective Armed
Forces preventive dentistry program. The first step
was preferential treatment of small caries lesions,
even at the expense of postponing treatment of exist-
ing advanced lesions. Now we come to the second
step and this one we should take — even at the ex-
pense of a cherished tradition. This step we call
the Cement-Alloy Program, restorations made of
equal parts of cement and alloy. The principle is
not new. Kronfeld 1 and Orban 2 recommended that
radical removal of carious dentin should be avoided
and that cariostatic temporary restorations should
be placed over remaining carious dentin to stimulate
development of secondary and sclerotic dentin. This
long recognized conservative procedure is currently
called an "indirect pulp-capping. 3 Recent research
reports have shown a higher percent of success from
indirect than from direct pulp-capping. 4 ' 5 About six
years ago, at the U.S. Naval Training Center, Great
Lakes, we modified this pulp conservation procedure
to the use of the cement alloy restoration to arrest
existing caries lesions which we would not otherwise
have been able to complete in the thousands of re-
cruits during their short nine-week recruit training
period. We did this in full confidence that those
cement alloys would conserve the pulp and prevent
further breakdown of those teeth for up to two years;
and we did this in full confidence that the dental
department at each recruit's next duty station would
find the pulps of those teeth in better condition and
would be able to complete the restoration. In the
cement alloy program, the cavities are opened up as
necessary with no special attention to cavity outline.
If possible, all caries is removed, and a sedative
cement base is placed as necessary. When carious
exposure of the pulp appears likely, an indirect pulp-
capping with remaining carious dentin is recorded in
the patient's record.
We have received mixed reactions to this pro-
gram. Some dental officers are strongly in favor of
this conservative practice; others are highly critical.
I respect the opinion of those critics but I believe
they are wrong. I recognize that this practice is con-
trary to the cherished professional tradition that each
restoration must be a jewel in itself. In the Navy,
the recruit input is so tremendous that we should
first arrest all dental caries and then go on to finer
permanent restoration. It is necessary to use some
cement alloys to hold selected caries lesions at a
standstill — until a subsequent dental facility will be
able to complete the treatment using the cement al-
loy as a base when the record shows that all caries
was removed; or in an indirect pulp-capping, to re-
move it after about six months, prior to permanent
U.S. NAVY MEDICAL NEWS LETTER
ANNUAL APPLICATION OF STANNOUS
The third important step is to develop an effective
method for providing the benefits of annual three
agent stannous fluoride treatment to all personnel.
It will interest you that the first full year data of
our clinical study at the U.S. Naval Submarine Medi-
cal Center, New London, has been completed. In
138 men, upwards of 70 per cent reduction in new
DMFT (decayed, missing, filled teeth) was observed
after one year, and in 50 men, after two years, up-
wards of 80 per cent reduction was seen. The treat-
ment which produced this dramatic reduction con-
sisted of stannous fluoride in three agents: a rubber
cup prophylaxis using 17.5 per cent stannous fluo-
ride in lava pumice; topical application of 10 per
cent stannous fluoride; and provision of stannous
fluoride dentifrice for daily home use. After indepen-
dent consultants have analyzed the data, a complete
report will be offered for publication.
This 70 to 80 per cent reduction was no surprise.
It was forecast by the preliminary results of March
1963 n . Those highly encouraging preliminary re-
sults led to serious thinking about how our Naval
Dental Corps would be able to provide this three
agent stannous fluoride benefit to all naval person-
nel. In this technic, the rubber cup prophylaxis takes
the most chair time. If we could eliminate that 30
minutes' chair time by using an alternate stannous
fluoride prophylaxis technic, we could come much
closer to the capability of providing annual three
agent stannous fluoride to all hands. Chemists ad-
vised us that it apparently was the burnishing of
stannous fluoride on the clean enamel surface which
caused the tin and fluoride uptake in the enamel.
If the subject, using his own toothbrush and the
stannous fluoride lava pumice mixture, could clean
his enamel surfaces as well as the average dental
technician using a rubber cup, then his "self-prophy-
laxis" should cause a similar tin and fluoride uptake.
On this line of reasoning, a clinical study was con-
ducted at the U.S. Naval Dental Clinic, Norfolk.
They found that groups of ten subjects under the
supervision of one dental technician, and brushing
their teeth for ten minutes, were able to clean their
enamel surfaces essentially as well as the average
dental technician with a handpiece mounted rubber
cup. This was demonstrated by the basic fuchsin
stain and scoring of remaining plaque. These data
have been accepted by the Journal of the American
Dental Association for publication.
After this encouraging information, the Dental
Research Facility, Great Lakes, initiated a study to
determine the tin and fluoride uptake in enamel after
self-prophylaxis, using biochemical analysis of ex-
tracted teeth. Bizarre results in the first trial appa-
rently resulted from experimental error; and this trial
is being repeated. A clinical study designed to com-
pare cariostasis form stannous fluoride self-polishing
versus rubber cup polishing, in groups of 150 men
for two years, is in the stage of organization. Like
our current New London study, it will take about
four years to obatin statistically valid data.
At this point we need to recognize the difference
between younger and older patients. As a whole,
18-25 year-old men have lesser calculus than older
patients and, therefore, the self-prophylaxis might
be sufficient for large numbers of them. This is less
likely to be satisfactory for older subjects who require
a true prophylaxis, including subgingival scaling.
These older men also have increasing need for pre-
ventive periodontal treatment. Therefore, they
should receive an annual complete prophylaxis and
the rubber cup stannous fluoride polishing, rather
than self -polishing. In my present thinking, the break-
ing point is probably in the man 25 years of age,
with the prospect of lowering it to 24, 23, etc., as
Now we might have postponed the Norfolk and
Great Lakes studies until after the New London
study was finished. On the contrary, just as our Navy
built the Polaris in minimal time by researching sev-
eral phases at the same time, we went ahead and
set up two paired clinical sites for development —
that is annual self-prophylaxis in men under 25 and
rubber cup polishing in men over age 25, with all
receiving the three agent stannous fluoride treatment.
Preventive dentistry rooms are constructed. A dental
technician with audio visual aids presents a lecture
to up to ten patients at a time on oral hygiene and
the proven benefits of stannous fluoride. Then he
demonstrates self-polishing. Then the men apply a
stannous fluoride polishing to themselves under his
supervision. Then the topical application is made
and daily use of a stannous fluoride dentrifice is
prescribed. The preventive dentistry room has audio-
visual equipment, rows of wash basins and associat-
ed accessories for self-polishing, as well as dental
chairs for topical application — all in a dignified pro-
Again, unwilling to wait several years for the re-
sults from our four test sites, we have gone ahead
U.S. NAVY MEDICAL NEWS LETTER
and instituted the program at one of our naval re-
cruit centers and at our largest Naval Dental Clinic,
at Norfolk. This method enables one technician to
treat fifty patients a day. At a recruit training center,
600 men can be treated in a day with almost no
interruption to our 97 dental officers stationed there.
It can be accomplished the first day the man is in
the Navy, with no reduction in the routine dental
treatment load. The benefit and hoped-for inhibition
of caries begins at once.
I have not touched on oral hygiene, patient educa-
tion, fluoridated water supplies, mouth guards for
athletes, early cancer detection, limited radiation,
and other aspects of preventive dentistry. Despite
our interest in all areas of prevention, I have limited
this discussion to those three basic principles which
I believe are most directly important to the U.S.
Navy's Preventive Dentistry Program.
I believe that the Navy can and will pull up even
and manage to provide a complete dental service
for the first time since World War II. The U.S. Naval
Academy is an outstanding example of the benefits
of preferential treatment of early lesions. From a
crash program of repair, a program of too little and
too late, it has gone to a fastidious and sophisticated
complete dental service characterized by early treat-
ment and the need for fewer dental officers. By the
use of the cement alloy as a holding method in re-
cruits who present an apparently insurmountable
work load, we prevent caries lesions from progress-
ing until we can restore them, Archimedes said,
"Give me a long enough lever an I can move the
world." Our present philosophies of preferential
treatment of early lesions and the cement alloy pro-
gram can go a long way toward elimination of caries
in naval personnel. It is just possible that self -polish-
ing in the three agent stannous fluoride system may
put the long handle on the lever.
1. Kronfeld, R.: Histopatholgy of the Teeth and their Surrounding
Structures, Lea and Febiger, Phila., 1939.
2. Orban, B.: Oral Histology and Embryology, C. V. Mosby Co.,
St. Louis, 1944.
3. Danele, J. J.: Clinical Evaluation of Indirect Pulp-Capping:
Progress Report, Abs 320, 39th General Meeting, Internat Ass
for Dental Research, 1961.
4. DiMaggio, J, J. and Hawes, R. R. : Continued Evaluation of
Direct and Indirect Pulp — capping, Abs 22, Proc 41st General
Meeting, Internat Ass for Dental Research. 1963.
5. DiMaggio, J. J., Hawes, R. R. and Kiryati, A.: Histological
Evaluation of Direct and Indirect Pulpcapping, Abs 23, Proc
41st General Meeting, IADR, 1963.
6. Scola, F. P., Nielsen, A. G. and Ostrora, C. A.: Clinical Evalu-
ation of Stannous Fluoride, Progress Report, Abs 339, Proc 41st
General Meeting, IADR, 1963.
CLINICAL SIGNIFICANCE OF DEHISCENCE
/. Roy Elliott,* DDS MS and Gerald M. Bowers** BS DDS MS.
Numerous articles have appeared in the literature
relating to alveolar dehiscence and fenestration 1-9 .
These anatomical defects of alveolar cortical plate
are most frequently observed by the periodontist
during mucogingival surgery; however, they are also
encountered during oral surgery and endodontic
procedures when a surgical flap is utilized. The pur-
pose of this article is to re-emphasize the significance
of alveolar dehiscence and fenestration and to re-
view the literature regarding these osseous defects.
Definition: Alveolar dehiscence denotes the ab-
sence of alveolar cortical plate resulting in a de-
nuded root surface while alveolar fenestration is a
circumscribed defect in the cortical plate exposing
facial or lingual root surface. These defects are not
to be confused with osseous deformities of periodon-
tal disease. In the case of dehiscence and fenestra-
* Commander, Dental Corps, U.S. Navy: U.S.S. Bryce Canyon
(AD-36), c/o FPO San Francisco, California..
** Lieutenant Commander, Dental Corps, U.S. Navy: Main Naval
Dispensary, Navy Dept., Wash., D. C.
tion, a connective tissue covering overlies the os-
seous lesion and is firmly attached to the root sur-
face by periosteal fibers 3 . In order to reflect this
soft tissue covering, considerable pressure is required
to detach the tissue. In periodontal disease, there
is pathological pocket formation associated with the
loss of alveolar bone.
Etiology: The etiology of alveolar dehiscence and
fenestration is unknown. Hereditary factors such
as tooth morphology, size and positioning must be
considered as possible etiologic factors. The larger
the roots and the more nearly a tooth approaches
the periphery of alveolar bone, the more likely the
occurrence of a bony defect.
Trauma from occlusion must also be considered
as an etiological factor, one that has received the
greatest emphasis in the literature.
Significance: It has been shown that surgical de-
fects and recession may result when mucogingival
U.S. NAVY MEDICAL NEWS LETTER
surgery is performed on teeth with alveolar de-
fects 4 -". A thin layer of combined cortical plate-al-
veolar bone proper often prevents the fenestration
from occurring as dehiscence. Consequently, bone
resorption in the region of a fenestration could rea-
dily produce dehiscence resulting in a postoperative
defect. Fenestration may actually be a stage in the
development of dehiscence, a stage enhanced by mu-
cogingival surgery, oral surgery or apicoectomy.
Fenestrations of the lingual surface of mandibular
third molars have been noted 4 . This phenomenon
may explain the submandibular swelling sometimes
associated with the abscessed third molar. This os-
seous defect of the lingual alveolar plate may also
permit direct access of a root tip or the tooth itself
into the submandibular space during surgical
Osseous defects of the alveolar plate may present
a treatment problem when apicoectomy is per-
formed. Endodontic therapy may fail as a result of
complete denudation of the root surface following
a surgical flap procedure on a tooth with a fenestra-
tion or dehiscence.
A relationship seems apparent between a narrow
zone of attached gingiva, high frenum attachment
and alveolar defects 11 . Teeth that are prominent
in the arch, such as the mandibular cuspids and
first premolars, have narrow widths of attached
gingiva and frequently a resultant high frenum at-
tachment. There is also a high incidence of alveolar
defects for prominent teeth or for those that appear
to be set off basal bone. When this triad is observed
— narrow width of attached gingiva, high frenum
or muscle attachments and labially positioned teeth-
— the clinician should consider the possibility of
either alveolar dehiscence or fenestration.
It has been stated that dehiscence is a possible
contributing factor in gingival recession 12 . It would
seem logical to assume that alveolar defects also
contribute to the rapid advance of periodontal
Incidence: A fairly high incidence of defects of
the cortical plate is reported (2.4% — 60.9% with
an average of 20.1%). The defects are most com-
monly observed on the facial surfaces of the maxil-
lary first molars and anterior teeth with the highest
incidence occurring on the mandibular cuspid, one
of the most common sites for mucogingival surgery.
Fenestrations occur more frequently in the maxilla,
whereas, dehiscence is predominant in the mandible.
Both fenestration and dehiscence frequently occur
bilaterally*- ' .
Diagnosis: The diagnosis of alveolar defects be-
comes a clinical problem since the roentgenogram
is ineffective as a diagnostic tool 4 . Areas of dehis-
cence are not probable and cannot be palpated".
As previously discussed, teeth with narrow zones
of attached gingiva, high frenum attachments and
gingival recession should be suspected. Until better
techniques are devised, diagnosis of fenestration and
dehiscence will depend on experience and clinical
Management: When defects of the alveolar corti-
cal plate are suspected, it is good surgical procedure
to avoid reflection of a mucoperiosteal gingival flap.
This can be accomplished by making the initial inci-
sion at the mucogingival line or within the alveolar
mucosa rather than detaching the gingival tissue.
When this approach is not feasible, sharp dissection
should be utilized and a fibrous connective tissue
covering preserved over the cortical plate or root
surface as the case may be.
Periodontoplastic procedures which help to avoid
postoperative defects include the apically reposi-
tioned flap 10 , the palatal approach to osseous sur-
gery 8 , periosteal separation 13 and the periosteal fene-
stration approach 14 .
Summary and Conclusion:
1 . A fairly high incidence of cortical plate defects
has been reported in the literature (average of ap-
proximately 20% ).
2. Dehiscence is predominant in the mandibular
arch; whereas, fenestrations are more commonly ob-
served in the maxilla.
3. While dehiscence and fenestrations are not
regarded as periodontal disease defects, they may
however contribute to the rapid advance of perio-
4. Surgical procedures exposing the alveolar cor-
tical bone may be complicated by the presence of
5. Diagnosis of alveolar defects depends on clini-
6. Defects were observed most frequently in
regions where the anatomical shapes and positioning
of teeth resulted in a thin covering of alveolar bone
proper and cortical plate.
7. When this triad is observed, narrow width of
attached gingiva, high frenum or muscle attachments
and labially positioned teeth, the clinician should
consider the possibility of either alveolar dehiscence
U.S. NAVY MEDICAL NEWS LETTER
1. Nabers, C. L., Spears, G. R., and Beckham, L. C, Alveolar
Dehiscence. Texas Dental Jour 78:4. 1960.
2. Kakehashi, S., Baer, P. N., and White, C. L., Comparative
Pathology of Periodontal Disease. I. Gorilla. Oral Surg., Oral
Med., and Oral Path., 16: 397, 1963.
3 Stahl, S. S., Cantor, M., and Zwig, E. Fenestration of the Labia!
Alveolar Plate in Human Skulls. Jour Am Soc Periodontists
4. Elliott, J. R., and Bowers, G. M, Alveolar Dehiscence and
Fenestration. Jour Am Soc Periodontists 1:245, 1963.
5. Farley, R. A Clinical Study of Dehiscence and Fenestrations,
Thesis. Ohio State Univ., 1962.
6. Baer, P. N-, Kakehashi, S., Littleton, N. W„ White, C. L„ and
Lieberman, J. E. Alveolar Bone Loss and Occlusal Wear. Jour
Am Soc Periodontists 1:91, 1963.
7. Bohannan, H. M. The Fixed, Long, Labial, Mucosal Flap in
Vestibular Alteration. Jour Am Soc Periodontists 1:13, 1963.
8. Ochsenbein, C. and Bohannan, H. M. The Palatal Approach
to Osseous Surgery, II. Clinical Application. 35: 54, 1964.
9. Donnenfeld, O. W., Marks, R. M., and Glickman, I. The Api-
cally Repositioned Flap — A Clinical Study. Jour Periodontics
35: 381, 1964.
10. Friedman, N. Mucogingivai Surgery: The Apically Reposi-
tioned Flap. Jour Periodontics 33: 328, 1962.
11. Bowers, G. M. A Study of the Width of Attached Gingiva.
Jour Periodontics 34: 201, 1963.
12. Elliott, J. R. Alveolar Dehiscence and Alveolar Fenestration.
Special Problem in Anatomy Research Report. Ohio State Univ.,
13. Corn, H. Periosteal Separation — Its Clinical Significance. Jour
Periodontics 33: 140, 1962.
14. Robinson, R. E. Mucogingivai Junction Surgery. Jour Calif
D A and Nev D Soc 33: 379, 1957.
SMOKING AND CANCER OF THE MOUTH,
PHARYNX AND LARYNX
Condict Moore, MD, JAMA 191(4),
January 25, 1965
This is a study of 102 patients that implicates
tobacco in the carcinogenic process more convinc-
ingly than previous studies because it approximated
an ideal planned human experiment, although it was
actually only an observation of a natural occurrence.
102 patients were divided into two groups.
Sixty-five continued smoking after their first mouth/
throat cancer. Thirty-seven quit smoking after their
first mouth/throat cancer. Within approximately six
years, twenty-one of the sixty-five patients who con-
tinued smoking acquired a second cancer. Only two
of the thirty-seven "quitters" developed second can-
cers in this same period. Such a finding would be
quite arresting in a laboratory study, but in a human
study, it is doubly so.
Although the article points out many other factors
in relationship to this study, it makes the summary
that smokers who stop after their first mouth/throat
cancer run only a small chance of getting another.
A considerable protection granted by the quitting
of tobacco in the study indicates that anyone having
mouth or throat cancer, with a fair prognosis, must
stop smoking. In those smokers who do get
mouth /throat cancer, tobacco appears to play a nec-
essary causative role in 90 percent of them.
AN IMPROVED SELF-CURING ACRYLIC
RESTORATION AND COMPARISON WITH
SILICATE CEMENT RESTORATIONS
Takae Fusayama, DDS DMSc, Hiroyasu Hosoda,
DDS DMSc, and Tsugio Iwamoto, DDS DMSc.
Tokyo Medical and Dental University, Tokoyo,
Japan. Jour Pros Den 14(3): 537—552.
Many disadvantages of the self-curing acrylic resin
restoration have been corrected by an improved tech-
nique, as presented in this article, of cavity prepara-
tion, insertion, finishing, and polishing. In a clinical
test, acrylic resin surpassed the silicate cement in
the significant qualities of discoloration, surface loss,
fracture, adaptation, recurrent caries, and pulp inju-
ry. Marginal adaptation was superior in the silicate
cement restorations. The present advantages of acryl-
ic resin broaden the indications for use. The brush-
on method permits insertion of several restorations
simultaneously. This study establishes that, although
acrylic resin does not fulfill all the requirements of
an ideal restorative material, it offers more advan-
tages than the silicate cement.
KNOW YOUR DENTAL CORPS
(First in a Series)
U.S. Naval Dental School, Bethesda, Maryland
The U.S. Naval Dental School is unique — the
only school of its kind in the world. Unlike most
dental institutions, which provide instruction in den-
tistry at the undergraduate and graduate level, this
School is devoted wholly to advanced education for
both dentists and their assistants. Its purpose is to
improve the practice of dentistry by educating pro-
fessional men in the most modern scientific tech-
niques; also, to train auxiliary personnel in effective
assistance procedures. Career dental officers there-
fore study the latest advances in the basic sciences
allied to clinical dentistry, as well as acquainting
themselves with the latest materials, methods, and
equipment related to patient' care. Similarly, dental
technicians receive advanced training in dental as-
sisting, accounting, personnel management, equip-
ment repair, and laboratory technics.
The School was established in 1922 by Surgeon
U.S. NAVY MEDICAL NEWS LETTER
General E. R. Stitt as the Department of Dentistry
of the U.S. Naval Medical School, in Washington,
D.C., where the Bureau of Medicine and Surgery
is now located. The first class of five dental officers
was convened on February 3, 1923, for a nineteen
weeks' course of postgraduate instruction in Naval
Dental Medicine. Coincidental with the convening
of the dental officers' course, the first group of 10
hospital corpsmen began a course designed to qual-
ify them to assist dental officers, to perform oral
prophylaxis procedures, and to fabricate various
prosthetic appliances. Instruction in these latter
procedures was required to support the newly author-
ized prosthetic service which was introduced at the
After being inactivated from 1932 to 1935, the
School was re-established as a separate command
on March 17, 1936. Since that time it has gradually
increased its enrollment and extended its functions
to meet the changing needs of the service. On Feb-
ruary 6, 1942, the School became a component
command of the newly constructed National Naval
Medical Center, in Bethesda, Maryland. Originally,
it occupied only the north wing of the Center, but
within a few years its rapid growth forced it to ex-
pand most of its scholastic functions into a tempo-
rary three-story barracks-type building, which it still
From its inception, the Naval Dental School has
had but little change in its threefold mission. Cur-
rently stated, this is: to conduct postgraduate and
advanced instruction for Dental Corps officers in the
various fields of dentistry peculiar to the needs of
the naval service; to instruct and train enlisted per-
sonnel to perform duties of dental ratings; and to
provide dental support to other activities of the Na-
tional Naval Medical Center.
Under its Commanding Officer, the U.S. Naval
Dental School is organized into nine departments.
Five of these are clinical: Oral Diagnosis, Periodon-
tics, Operative Dentistry, Oral Surgery, and Prostho-
dontics. The other four are educational: Officer
Education, Enlisted Education, Audiovisual, and
Publications. However, the officers of the clinical
departments have a vital part in the educational pro-
grams, and there is a free flow of ideas and infor-
mation between all staff members. There is also
a free exchange of teaching talent and laboratory
facilities among all units of the Center.
The core of the officer education program is the
Graduate Course for dental officers who usually have
about 5 to 8 years of service in the Regular Navy
at the time of their selection for instruction. In this
intensive 10-month program, divided between class-
room, clinic, and laboratory, 28 dental officer stu-
dents learn the latest advances in the basic sciences,
as well as in clinical dentistry and research. The
courses are conducted by experienced naval and civil-
ian instructors, many of whom are diplomats of
the dental specialty boards. Several Naval Dental
School officers having appointments to the staff of
the Graduate School of Georgetown University, as
well as regular instructors of the University, conduct
certain lectures and laboratory sessions which permit
students to receive 1 2 hours of credit toward a Mas-
ter of Science degree at Georgetown University.
Each year, approximately eight dental officers are
assigned to the Dental School for residency instruc-
tion in Periodontics, Prosthodontics, Oral Surgery,
Oral Pathology, Endodontics, and Oral Medicine.
In addition to the Graduate Course and the residen-
cies, the Officer Education Department annually of-
fers 11 one-week courses in the dental specialties.
These are open to all dental officers of the Armed
Forces and other Federal Agencies.
The Enlisted Education Department conducts 6-
month advanced courses for general and prosthetic
dental technicians and a basic course for dental
The Audiovisual Department develops plans for
motion pictures, television programs, videotapes,
and scientific exhibits on subjects ranging from oral
hygiene to complex professional procedures, and
provides technical assistance in their production.
The Department also prepares slide-illustrated lec-
tures, table clinics, and functional training aids for
The Publications Department prepares and pub-
lishes professional, technical, and informational ma-
terials for the School and for the entire U.S. Naval
Dental Corps. The best known of these are the pro-
fessional correspondence courses for dental officers
and the three handbooks for dental technicians.
Correspondence courses in dental subjects are avail-
able only in the education program of the U.S.
Naval Dental Corps; therefore, the Publications
Department administers these courses for all Regular
and Reserve dental officers of the Armed Forces
and other Federal agencies.
Clinical services range widely from basic instruc-
tion in preventive dentistry to extensive dental reha-
bilitation and complex facial surgery. These services
also include histopathological examination of speci-
mens for all naval dental facilities. The clinical serv-
ices are supported by such research as the investi-
U.S. NAVY MEDICAL NEWS LETTER
gation of drugs to make treatment easier and more
effective, and the improvement of equipment and
technics for more efficient and comfortable
Through its educational, clinical, and research
programs, the Naval Dental School contributes in
many ways toward the improved oral health of naval
and Marine Corps personnel throughout the world.
PERSONNEL AND PROFESSIONAL NOTES
Dental Officer Presentations. CAPT Frank J. Kra-
tochvil Jr. DC USN, U.S. Naval Dental School,
NNMC, Bethesda, Maryland, presented an illus-
trated lecture, entitled, "Anatomy of Temporo-Man-
dibular Joint as it Effects Occlusion," before the
Dental Science Club on 23 February 1965 in Wash-
LCDR William K. Bottomley DC USN, U.S. Na-
val Dental School, NNMC, Bethesda, Maryland, pre-
sented a lecture, entitled, "Problems in the Treat-
ment of the Herpes Simplex-Like Syndrome," before
the Washington Section of the International Associa-
tion for Dental Research on 1 March 1965 in Be-
LCDR James E. Klima DC USN, U.S. Naval
Training Center, Great Lakes, Illinois, presented an
illustrated lecture, entitled, "The Preventive Den-
tistry Program at the Great Lakes Naval Training
Center," before the Wisconsin Special Service Den-
tists and staff on 28 January 1965 at the Winnebago
State Hospital, Winnebago, Wisconsin.
CAPT Philip J. Boyne DC USN, USS Bon
Homme Richard CVA-31 presented a lecture, enti-
tled, "A Study of Osseous Healing Following Osteot-
omy for the Correction of Mandibular Progna-
thism," before the Dental Staff of the U.S. Naval
Hospital, San Diego, California on 22 January 1965.
CAPT Boynes lecture was. the same paper which
won the Research Award of the Year by the Ameri-
can Society of Oral Surgeons at Las Vegas, Nevada
in -November 1964.
LT Charles L. Stoup DC USN, U.S. Naval Hos-
pital, Chelsea, Massachusetts, presented a clinical
demonstration, entitled, "The Necessity for Correc-
tion of Laboratory and Restoration Errors in Com-
plete Denture Construction," before the Massachu-
setts Dental Society on 18 January 1965 in Boston,
LT Robert A. Lawton DC USN, U.S. Naval
Hospital, Chelsea, Massachusetts, presented a lec-
ture, entitled, "A Technic for the Construction of
Post Crowns for Posterior Teeth," before the Massa-
chusetts Dental Society on 3 8 January 1965 in
Assignment of Personnel to Dental Technicians
School, Class "A". BUPERS has advised the Dental
Division that the planned input for the Class "A"
school in fiscal years 1966 and 1967 will be 274
students as opposed to the 648 in fiscal year 1965.
Due to this reduction, the number of "strikers"
to be ordered to the school will be reduced. Only
personnel who meet all eligibility requirements spec-
ified in BUMEDINST 1510.6B should be utilized
as strikers and/or recommended for school.
A critical shortage of personnel in the AN and
TN rates exists. Men in those rates should not be
utilized as strikers as it is extremely unlikely they
will be authorized to attend Dental Technicians
Armed Forces Desert Dental Society Meeting. CAPT
Harry B. Mclnnis DC USN, Dental Officer, U.S.
Marine Corps Air Station, El Toro, Santa Ana, Cali-
fornia hosted a meeting of the Armed Forces Desert
Dental Society on 22 January 1965 at Norton Air
Force Base, San Bernardino, California. Fifty-one
members and guests attended the meeting from
twenty-seven activities located throughout the far-
thest reaches of the ELEVENTH Naval District.
CAPT Mclnnis is a charter member of the Armed
Forces Desert Dental Society. He joined the group,
which formed from a nucleus of five activities, in
1951 when he was stationed at Barstow, California.
CAPT Perry C. Alexander DC USN, U.S. Naval
Dental Clinic, Long Beach, California, presented a
lecture, entitled, "Movements of the Condyle."
Navy Dentist Elected President of CZ Dental Soci-
ety. The 35th Annual Panama Canal Zone Dental
Society Meeting was held 6 February 1965 at
Albrook Air Force Base, Canal Zone. The meeting
was honored by the participation of a number of
distinguished dentists, including Dr. Fritz A. Pier-
son, President of the American Dental Association.
Dr. Pierson discussed several interesting activities
of the ADA including: the continuous efforts to as-
sist exiled Cuban dentists to practice in the United
States; the support of Project USS Hope; and the
U.S. NAVY MEDICAL NEWS LETTER
Association's support of the Institute of Internation-
al Education, a private non-profit organization that
administers many United States grants to foreign
dental graduate students.
The meeting, moderated by LCOL H. J. Lord
Jr. DC USAF, was held in the simultaneous transla-
tion facility of the USAF School for Latin America
to accommodate the Panamanian representatives.
CAPT S. Robert Howell DC USN, 15 ND Dental
Officer, was elected President of the Canal Zone
Dental Society for the ensuing term.
Sub Base Dentists Assist County Dentists in Nation-
al Children's Health Week. Eleven Navy Dental
Officers of the U.S. Naval Submarine Base, New
London, assisted the New London County Dental
Association in promoting National Children's Dental
Health Week, February 7-13. The theme for this
year was "Heal Their Teeth — Happy Life."
Equipped with a movie on Oral Hygiene, large mod-
els of teeth and toothbrushes, and pamphlets, enti-
tled, "I must Brush My Teeth," these officers visited
eleven schools in the New London-Groton area dur-
ing the week for a series of lectures on the impor-
tance of dental health.
The talks emphasized the importance of proper
nutrition and oral hygiene in the preservation of
Dental Health. The lectures were arranged by Dr.
Vincent F. Masin of the New London County Dental
Association, Miss Ann Cowhey of the New London
Department of Health and CAPT George O. Stead,
Senior Dental Officer at the Base.
Charleston Military-Civilian Dental Meeting. CAPT
William Seidel DC USN, SIXTH Naval District
Dental Officer recently announced that Navy Dental
Officers hosted a meeting of seventy-five Armed
Forces and civilian dentists in the Charleston area.
The meeting was held at the Naval Base, Charleston,
and featured several clinics in addition to a showing
of the Navy film Periodontal Disease — Prevention
and Early Treatment. The clinicians and their pres-
entations were: CAPT A. L. Raphael DC USN,
Naval Station, "Amalgam Splints for Periodontally
Involved Teeth," CDR F. M. Amman DC USN,
USS Howard W. Gilmore (AS-16), "An Altered
Cast Technique for Posterior Extension Partial Den-
tures," CDR F. A. Marmarose DC USN, USS Ever-
galdes (AD-24), "A Practical and Economical
Method of Converting Dental Operating Chairs to
Modern Contour Type," LCDR C. G. Strange DC
USN, Naval Station, "The Dowel Abutment Crown."
INFLUENZA AND INFLUENZA-LIKE ILLNESS
DHEW PHS Morbid & Mortal Wkly Rpt CDC Atlanta, Ga., 14(5): 41-42 & 45;
14(6): 53-55; and 14(8): 73-74, February 6, 13, and 27, 1965.
UNITED STATES: Since early January 1965,
Group A influenza infections have been confirmed
by laboratory methods in the following states: New
England States, Pennsylvania, Missouri, Iowa, Mich-
igan, Alabama, Kansas, Illinois (Chicago), and
Georgia (Atlanta). Unconfirmed, but clinically sus-
pect, outbreaks of influenza-like illness have been
reported from Maine and Mississippi.
At present, A 2 influenza virus isolates have been
recovered in New York, New Jersey, Connecticut,
Pennsylvania, Missouri, Kansas, Michigan, Georgia
(Atlanta), and Illinois (Chicago). All geographic
areas, with exception of New England States, are
well below the epidemic threshold. The new Eng-
land States continue to have excess mortality at
the same levels previously reported; Middle Atlantic
States are within normal limits.
NEW YORK: Upper respiratory illness has been
prevalent throughout the State during the past
weeks. Three A H influenza viruses have been iso-
lated from sporadic cases during mid-January in 2
U.S. NAVY MEDICAL NEWS LETTER
VERMONT: Since mid-January, outbreaks of
acute febrile respiratory disease with systemic symp-
toms have been noticed in 3 counties. Serologic con-
firmation of influenza A has been reported from 2
counties. Virus silation attempts are in process.
NEW HAMPSHIRE: The scattered outbreaks of
influenza-like illness in New Hampshire have now
been serologically confirmed as type A influenza.
MISSOURI: A, influenza has been identified in
2 patients in Princeton, Missouri, by hem agglutina-
MISSISSIPPI: A focal outbreak of acute febrile
respiratory disease occurred in the rural area of
Rankin County on January 25, characterized by rap-
id onset, fever, chills, headache, arthralgias and
upper respiratory symptoms. The first appearance
of disease was in school age children (15 to 20%)
with secondary cases in families being observed. Ser-
ologic confirmation of this outbreak is in process.
ALABAMA: A recent outbreak of widespread
influenza, particularly affecting younger age groups,
was reported during the 2nd week of February 1965
from Clarke County; the southern portion was most
heavily involved. Adults were affected with an in-
creased number of cases of pneumonia being re-
ported. A serological survey carried out on unpaired
acute and convalescent sera specimens demonstrated
significantly increased levels of HI antibodies to type
A influenza during the convalescent phase. Virus
isolation attempts are underway.
IOWA: In mid-February, Type A influenza was
serologically confirmed. Some 3 weeks ago, an
abrupt outbreak of acute febrile respiratory disease
developed in a small town in southeastern Iowa.
A major proportion of the cases occurred among
students attending a liberal arts college in the com-
munity, many of whom had returned only recently
from visits in various parts of the East. Paired sera
specimens from 2 cases demonstrated a rise in HI
titer to influenza type A.
MICHIGAN: There has been a general increase
in acute febrile respiratory disease during the past
months, particularly in the Grand Rapids, Monroe,
Lansing and Ann Arbor regions. Illnesses have been
mainly in school children because of "spotty" school
absenteeism. An A 2 influenza virus antigenically sim-
ilar to A^/Taiwan/64 has been isolated from a
student where increased numbers of influenza-like
illnesses have been observed in the first week of
KANSAS: Influenza-like illness has been ob-
served in 5 counties so far this winter. In 2 counties
the illness has been confirmed as influenza type A
by CF test. A 2 virus has been isolated by the CDC
Laboratory, Kansas City Field Station, from a lung
tissue of a fatal case of pneumonia occurring in
GEORGIA: Georgia, previously unreported, has
experienced a widespread occurrence of febrile dis-
ease much of it being respiratory during February.
There has been serological confirmation of type A
influenza and presumptive virus isolation of type A^
influenza in several areas of Atlanta, Georgia, in
ILLINOIS: Type A a influenza viruses have re-
cently been isolated from several university students
in the Chicago area.
COLORADO: Scattered occurrence of influen-
za-like illness has been observed in Colorado, partic-
ularly the Denver area, since mid-February. Virus
isolation and serological confirmation of type B in-
fluenza was obtained from one Denver outbreak.
EASTERN GERMANY (January 1965): The
World Health Regional Virus Reference Laboratory,
Prague, Czechoslovakia, has reported by telephone
to the WHO that outbreaks of influenza-like illness
occurred in January in Eastern Germany, mainly in
the northern part towards the Baltic coast. Serologi-
cal evidence of infection with virus A 2 , from scat-
tered outbreaks, have been obtained and 4 strains
of virus A 2 have been isolated by laboratories in
FRANCE (25 Jan 1965): Serological evidence of
infection with virus A-, was obtained in Paris and
environs, as well as in the east, west and center of
the country. Serological evidence of infection with
virus B was obtained in Paris and its suburbs, and
in the Northeast of the country (Aisne Department).
USSR (29 Jan 1965): Outbreaks of influenza were
reported by telephone to the World Health Organi-
zation by the WHO Virus Reference Center in Mos-
cow. Preliminary reports from Moscow indicated
that an epidemic began in Leningrad about 9 Jan-
uary 1965, reached its peak about 18 January and
is now declining. Thousands of cases, many in chil-
dren, occurred but the incidence was less than in
U.S. NAVY MEDICAL NEWS LETTER
the epidemic there 3 years ago. The disease was
A sharp increase in influenza-like illness has been
reported from Arkhangelisk in the North, Khaba-
rovsk in the East, and from Tallin, Riga, and
Influenza virus A 2 was isolated from cases in
Leningrad and Moscow. Primary isolations were
made with some difficulty. Strains have been sent
to the 2 International Influenza Centers, London and
Atlanta for further study (identified as A,/Singa-
Since December 1964, about 4 million people in
the USSR have been vaccinated with live influenza
vaccine. Because of the low incidence of influenza
in the past 2 or 3 years in the USSR, it was thought
that an epidemic might occur this year and clinics
and hospitals increased their supplies of antibiotics
and other drugs as a precaution.
JAPAN (Feb): Sporadic outbreaks of influenza-
like illness are being reported. A strain of influenza
virus A 2 has been isolated from a case in a Tokyo
RUBELLA IN CONTACTS OF INFANTS WITH
DHEW PHS Morbid and Mortal Wkly Rpt, CDC
Atlanta, Ga., 14(5): 44-45, Feb 6, 1965.
Nine cases of rubella among medical personnel
caring for infants with rubella-associated anomalies
have been documented. A large proportion of chil-
dren with rubella-associated anomalies excrete ru-
bella virus, sometimes for long periods following
birth, indicating that the risk of acquired infection
from these children may be high.
A group at the New York University School of
Medicine has studied more than 100 infants with
congenital defects thought to be caused by rubella
infection acquired in utero. An interfering agent
with properties characteristic of rubella virus has
been isolated from throat swabs, urine specimens
and/or rectal swabs obtained from 60-70% of these
patients. Although the well-recognized "classical"
defects such as congenital heart disease and cataracts
have been seen most frequently, more obscure con-
ditions such as thrombocytopenic purpura and/or
splenomegaly without any detectable anomaly have
also been associated with viral excretion.
Questioning nursery and pediatric ward personnel
who cared for these infants at hospitals throughout
New York City, the authors encountered 8 nurses
and 1 resident physician who had developed an ill-
ness typical of rubella with an onset of symptoms
approximately 2 to 3 weeks after close and pro-
longed physical contact with these babies. Significant
is the fact that certain of the infants excreted virus
for months. For example, the defective infant was
almost 9 months old at the time of contact in case
Case 1. Bar., a 30-year-old married nurse, was
exposed to many pregnant patients with rubella in
the Spring of 1964 while working in the Obstetrics
Clinic. In August 1964, she was transferred to the
Premature Nursery. On 23 Nov 1964, she admitted
a newborn infant with typical rubella- associated de-
fects and cared for this infant daily thereafter. On
16 Dec 1964, she developed typical rubella mani-
fested by a maculopapular rash, occipital, postauric-
ular, cervical, auxiliary and inguinal adenopathy,
and low grade fever. The diagnosis was confirmed
by isolation of virus from her throat swab on the
3rd day of rash. Rubella virus had previously been
detected in throat and rectal swabs obtained from the
Case 4. Dow., a 33-year-old single nurse, cared
for a newborn infant with severe rubella embryo-
pathy on 25 and 26 Oct 1964, prior to leaving for
vacation. On 16 Nov, while still on vacation, she
developed rubella characterized by a rash which per-
sisted for 3 days, occipital and postauricular lymph
adenopathy, and painful swelling of her interpha-
langeal joints and wrists. The arthritis cleared after
48 hours. Her roommate, a nurse who worked in
another unit at the same hospital, developed a simi-
lar illness with rash, adenopathy and joint manifesta-
tions 14 to 16 days later. The newborn infant was
shown to be excreting rubella virus in throat swab
and urine specimens.
Case 8. Sha., a 28-year-old pediatric resident, was
exposed on 10 Nov 1964, to a 1 -month old infant
with "rubella syndrome," characterized by congeni-
tal heart disease and cataracts. He examined this
infant regularly until 29 Nov, when he developed
rubella manifested by rash, adenopathy and back
pain. Sixteen days later, his wife and child also devel-
oped typical rubella. The defective infant was still
a virus-excretor when last studied at the age of 2Vi
months. No attempt was made to isolate virus from
the pediatric resident or his family.
Two features common to the 9 cases described
provide strong circumstantial evidence implicating
these virus-excreting infants as the source of rubella
U.S. NAVY MEDICAL NEWS LETTER
infection. One is the incubation period, an appro-
priate 2 to 3 weeks after intimate contact. The sec-
ond is the low incidence of rubella in the general
community at the present time.
In view of these observations, it is recommended
that infants born with rubella-associated anomalies
be managed with the same precautions employed
for patients with rubella. It obviously is most impor-
tant for women in the first trimester of pregnancy
to avoid exposure to these infants.
(Louis Z. Cooper, M.D., et. al, Depts Med & Ped.,
New Yord Univ School Med., New York.)
HOSPITAL PERSONNEL DEVELOPING RUBELLA AFTER CARING FOR
INFANTS WITH "RUBELLA SYNDROME"
Time of Intimate Contact with Time of Onset
Possible Virus-Excreting Infants of Rash
F November 23 — December 15 December 16
F December 7 — December 24 December 25
F September 10 — October 29 November 2
F October 25 — October 26 November 9
F October 25 — December 4 December 5
F August 22 — November 5 November 6
F December 18 — January 8 January 9
M November 10 — November 28 November 29
F December 15 — January 10** January 18
•Rubella virus isolated from throat swab at time of illness. . . „„„„„„„„
** Infant with multiple, classical rubella anomalies and history of maternal rubella during first trimester or pregnancy.
CDC Hepatitis Surveillance Rpt 21, Pg 25-27,
December 31, 1964.
All 4 of the known epidemics of infectious hepa-
titis associated with the ingestion of raw shellfish
from commercial sources have begun in late fall.
The month of peak incidence was January in 3 of
these, and March in the fourth. In view of this sea-
sonal pattern persons responsible for hepatitis sur-
veillance on a state or local basis should intensify
efforts to detect shellfish-associated epidemics at this
time of year. The smallest epidemic to have been
described accounted for 84' cases related to the
ingestion of raw oysters from Pascagoula, Mississip-
pi 1 . All 3 of the clam-associated epidemics involved
over 100 cases each *•*»♦. With improved tech-
niques for detection, it should be possible to uncover
smaller outbreaks, and, by means of prompt reme-
dial action, bring about a reduction in hepatitis mor-
bidity. It seems worthwhile, therefore, to review
some of the epidemiological indices which may serve
as "warning signals" for the presence of such
I. Age and Sex Distribution. A shift in the age
distribution of reported hepatitis cases toward a
greater proportion of adults was a clue to one epi-
demic of the past. Analysis of the age and sex distri-
bution in known shellfish-associated epidemics has
shown a preponderance of young adult males. While
age and sex data are worth monitoring because they
are almost always available on a routine basis, they
are, unfortunately, insensitive indicators. They are
likely to reflect only epidemics of major proportions.
2. Socioeconomic Pattern. While raw clams and
oysters are consumed to a varying extent in different
areas of the United States, such raw shellfish inges-
tion is often a middle and upper-class phenomenon.
The appearance of a number of such cases, there-
fore, should alert health authorities to the possibility
of a shellfish-related epidemic.
3. History of Personal Contact. A question con-
cerning contact with a known case of hepatitis
during the 2 months prior to onset is often included
on surveillance forms used by state and local health
departments. An analysis of 7907 forms submitted
to CDC for cases diagnosed as infectious hepatitis
with onsets during epidemiological year 1963-64 is
in Table 1. The responses to the question about
personal contact were tabulated separately for pa-
tients who denied raw shellfish ingestion and those
who had eaten raw clams or oysters during the two
months prior to onset.
4. History of Raw Shellfish Ingestion. A question
about raw shellfish ingestion should be a part of
the epidemiological history obtained on adult cases.
The question should specifically relate to raw clams
or raw oysters during the two months prior to onset.
U.S. NAVY MEDICAL NEWS LETTER
There is no evidence that other forms of shellfish,
such as shrimp and lobster are related to hepatitis.
Provided the cooking process is adequate, there is
also no need to obtain information about cooked
shellfish. The results of questions relating to the gen-
eral habit of shellfish ingestion or to periods of
greater than 2 months are difficult to interpret. If
a hepatitis patient admits raw shellfish consumption
on the preceding 2 months, detailed information as
to the time(s) and place (s) of eating should be
sought. In this way it may be possible to link several
cases to a single source of supply, and thus raise
the suspicion of a common source epidemic. If a
routine tabulation of hepatitis surveillance data
shows that more than 10% of adult cases give a
history of raw clam or oyster ingestion, the suspicion
of health authorities should be aroused. If the per-
centage exceeds 15, an investigation should begin.
Number of Percent with
Cases Personal Contact
Number of Percent with
Cases Personal Contact
40 & over
• Includes cases from the 1964 clam-associated epidemic in Southern New Jersey and Greater Philadelphia area.
In all but the oldest age group a smaller percent-
age of shellfish-positive cases reported contact with
a known case of hepatitis. Thus, if the proportion
of cases with a history of personal contact is signifi-
cantly lower than that shown above for "shellfish-neg-
ative" cases, the presence of an epidemic related
to a common source mode of spread, possibly raw
shellfish, should be suspected.
1 Mason, J. O., and McLean, W. R.: Infectious Hepatitis Traced
to the Consumption of Raw Oysters. Amer Jour Hyg 75: 90-111,
2 Dougherty, W. J. and Attman, R.: Viral Hepatitis in New
Jersey, 1960-61. Amer Jour Med 32: 704-736, 1962.
3. U.S. Communicable Disease Center, Hepatitis Surveillance Report
No. 18, March 31, 1964.
4. U S. Communicable Disease Center, Hepatitis Surveillance Re-
port No. 19, June 30, 1964.
DECLARATION OF HELSINKI
WHO Chronicle, WHO 19: 1, "Declaration of
Helsinki. Recommendations Guiding Doctors in
Clinical Research." January 1965.
It is the mission of the doctor to safeguard the
health of the people. His knowledge and conscience
are dedicated to the fulfillment of this mission.
The Declaration of Geneva of the World Medical
Association binds the doctor with the words: "The
health of my patient will be my first consideration"
and the International Code of Medical Ethics de-
clares that "Any act or advice which could weaken
physical or mental resistance of a human being may
be used only in his interest."
Because it is essential that the results of labora-
tory experiments be applied to human beings to
further scientific knowledge and to help suffering
humanity, the World Medical Association has
prepared the following recommendations as a guide
to each doctor in clinical research. It must be
stressed that the standards as drafted are only a
guide to physicians all over the world. Doctors are
not relieved from criminal, civil and ethical responsi-
bilities under the laws of their own countries.
In the field of clinical research a fundamental dis-
tinction must be recognized between clinical research
in which the aim is essentially therapeutic for a pa-
tient, and the clinical research, the essential object
of which is purely scientific and without therapeutic
value to the person subjected to the research.
Clinical research must conform to the moral and
scientific principles that justify medical research and
should be based on laboratory and animal experi-
ments or other scientifically established facts.
Clinical research should be conducted only by
scientifically qualified persons and under the supervi-
sion of a qualified medical man.
Clinical research cannot legitimately be carried
out unless the importance of the objective is in pro-
portion to the inherent risk to the subject.
U.S. NAVY MEDICAL NEWS LETTER
Every clinical research project should be preceded
by careful assessment of inherent risks in compari-
son to foreseeable benefits to the subject or to
Special caution should be exercised by the doctor
in performing clinical research in which the person-
ality of the subject is liable to be altered by drugs
or experimental procedure.
Clinical Research Combined with Professional Care
In the treatment of the sick person, the doctor
must be free to use a new therapeutic measure, if
in his judgment it offers hope of saving life, re-estab-
lishing health, or alleviating suffering.
If at all possible, consistent with patient psycholo-
gy, the doctor should obtain the patient's freely given
consent after the patient has been given a full
explanation. In case of legal incapacity, consent
should also be procured from the legal guardian;
in case of physical incapacity, the permission of the
legal guardian replaces that of the patient.
The doctor can combine clinical research with
professional care, the objective being the acquisition
of new medical knowledge, only to the extent that
clinical research is justified by its therapeutic value
for the patient.
Non-therapeutic Clinical Research
In the purely scientific application of clinical re-
search carried out on a human being, it is the duty
of the doctor to remain the protector of the life
and health of that person on whom clinical research
is being carried out.
The nature, the purpose and the risk of clinical
research must be explained to the subject by the
Clinical research on a human being cannot be
undertaken without his free consent after he has
been informed; if he is legally incompetent, the con-
sent of the legal guardian should be procured.
The subject of clinical research should be in such
a mental, physical and legal state as to be able to
exercise fully his power of choice.
Consent should, as a rule, be obtained in writing.
However, the responsibility for clinical research al-
ways remains with the research worker; it never falls
on the subject even after consent is obtained.
The investigator must respect the right of each
individual to safeguard his personal integrity, espe-
cially if the subject is in a dependent relationship
to the investigator.
At any time during the course of clinical research
the subject or his guardian should be free to with-
draw permission for research to be continued.
The investigator or the investigating team should
discontinue the research if, in his or their judgment,
it may, if continued, be harmful to the individual.
ANTIMICROBIAL PROPHYLAXIS FOR INDI-
A HISTORY OF RHEUMATIC FEVER
The prevention of streptococcal infection in indi-
viduals who have had rheumatic fever is duscussed
in the Naval Medical Publication entitled, "Treat-
ment and Prevention of Streptococcal Disease and its
Sequelae" (NAVMED P-5052-17), which is cur-
rently under revision. A portion of paragraph 7,
which will remain unchanged in the revised edition,
"The Commission of Streptococcal Disease of the
Armed Forces Epidemiological Board has recom-
mended that individuals who have had rheumatic
fever, as indicated by a valid history of rheumatic
fever, or the presence of rheumatic heart disease,
receive continuous antimicrobial prophylasis. Opin-
ion varies on the length of time to continue prophy-
laxis after the last attack of rheumatic fever, but
five years is probably a minimum. Evidence of heart
damage, duty in high exposure environment and age
under 40 years may indicate extension of this time."
Recruit training, service school training, sea duty,
and, indeed, any situation in which men are forced
into intimate living conditions, should be considered
a high exposure environment.
— Communicable Disease Branch, PrevMedDiv.
Some confusion evidently still exists concerning
the use of repellents for personal protection from
bites due to mosquitoes, black flies, deer flies, fleas,
ticks, chiggers, and leeches. The standard military
repellent deet, FSN 6840-753-4963, supplied in 2
ounce polyethylene bottles, is effective to varying
degrees against all of the above pests. Furthermore,
it is the most effective repellent available for most
of these pests. See BUMED INSTRUCTION
6250.10 for further details.
In regard to leeches, both land and aquatic
leeches may be encountered in certain tropical or
sub-tropical areas of the world. Deet is effective, as
mentioned above; however, land leeches are usually
found only where the climate is warm and damp.
U.S. NAVY MEDICAL NEWS LETTER
Therefore, deet applied to skin and clothing may
be removed by brushing against wet vegetation, or
by excessive sweating, requiring frequent reapplica-
tions of the repellent. Aquatic leeches present a
more serious problem, because deet is washed off
in water. An aquatic leech repellent consisting
of a 25% deet — 75% lanolin mixture has been de-
veloped for special military uses; the lanolin content
resists wash-off. This mixture is not a standard stock
Deet is the recognized common name of the chem-
ical diethyltoluamide. FSN 6840-753-4963 consists
of 75% deet and 25% denatured ethanol. Deet also
is the active ingredient in the better commercial
repellents, usually in 15 to 50% strengths; the stand-
ard military item is a better repellent because pro-
tection time agaist biting insects, ticks, etc., is deter-
mined by the actual amount of deet present on skin
or clothing. For this reason, the deet-lanolin aquatic
leech repellent is effective on dry skin only for about
Vz of the time that standard military deet is effective.
— Vector Control Section, PrevMedDiv.
KNOW YOUR WORLD
DID YOU KNOW:
That a flock of geese are the latest participants
in Florida's efforts to control water weeds without
The geese are clipping away at weeds along the
lagoon banks of the Margate Sewage Treatment
Plant's polishing pond. In Broward County, Florida,
sea cows are being imported to clean up ponds and
keep aquatic weeds under control.
No report is available as yet on the progress the
British are making with the 15,000 carp they im-
ported from Hong Kong to gobble up the weeds
which clog the water inlets of a large power station
on the Irish Sea coast in Lancashire. ( 1 )
That poor design of ponds cause disease?
Recent outbreaks of encephalitis throughout the
nation have focused attention on the need for rigid
design control of small water-retention structures.
A water management researcher from Georgia told
a meeting of the American Society of Agricultural
Engineers that farm ponds and small reservoirs de-
signed to retard flood waters are ideal breeding
grounds for disease-carrying mosquitoes and that a
study of the mosquito potential of 22 small flood-re-
tarding reservoirs showed all of them produced mos-
quitoes to some extent. In farm ponds, control is
easiest when the shore line of the pond is deepened
during construction. Investigations in Mississippi
and Tennessee showed that there was little or no
mosquito production in reservoir lakes where the
shore line was deep and clean. (2)
That in India's Malaria Eradication Campaign in
1963, there were employed:
1. 550 physicians and entomologists and 34,000
U.S. NAVY MEDICAL NEWS LETTER
2. 26,000 surveillance workers, each responsible
for a population of 10,000 living in about 2,000
houses which were visited twice a month to detect
3. 39 million bloodsmears were taken and ex-
amined for malaria parasites.
4. 38 million houses were sprayed with insecti-
cides, each house with an average sprayable surface
of 170 square meters, a total of 6,500 square
5. 15,000 tons of DDT were used. (3)
That rats were responsible for scrub typhus in
The Faculty of Tropical Medicine at the Univer-
sity of Medical Sciences in Bangkok, Thailand
report that investigations led to isolation of Rickett-
sia tsutsugamushi from field rodents and patients.
Various field rats seemed to be the main reservoir
hosts. The chigger has a carrier role in transferring
rickettsia from rats to humans. (Jour Trop Med Hyg
67: 215-219, Sept 1964.) (4)
That the average patient entering a mental hospi-
tal today has a 70% to 85% chance of leaving
the hospital considerably improved or totally recov-
ered within a few months. (5)
That of the 1 to 4 year-old age group of U.S.
children last year 40% had not received a smallpox
That Soviets have more physicians per 1,000 pop-
ulation than any other country in the world?
There are presently about 500,000 physicians and
100,000 pharmacists in the Soviet Union. Soviet
medical authorities, however, state that the hygienic
conditions leave something to be desired in some
areas of the country. In remote districts such as
Kzbek, Kirkhgisia, Patschik Republic, among others,
there are no private or public baths because the
water supply is either out of order or not yet avail-
That during 1963, 295 cases with 40 deaths and
141 carriers of diphtheria were officially reported
to the Diphtheria Surveillance Unit, CDC, Atlanta,
27% less than had been reported in 1962. This de-
cline has been continuous since the inauguration of
a nationwide surveillance program. In 1921, 206,-
989 cases were reported or 20.14 per 100,000 popu-
lation; 0.17 per 100,000 population in 1963. Every
year since 1946, when diphtheria toxoid and antibi-
otics became widely available, the case rate has de-
clined, although the case-fatality ratio has increased.
1. Water Newsletter, 7(1): 2, Jan 8, 1965.
2. Water Newsletter, 7(1 ) : 3, Jan. 8, 1965.
3. WHO Press Release, Pg 2, Jan 19, 1965.
4. JAMA, 190(12): 1089 (133), Dec 21, 1964.
5. Science News Letter, 86(11): 172, Sept 12, 1964.
6. Science News Letter, 86(24): 380, Dec 12, 1964
7. JAMA, 191(1): 165, Jan. 4, 1965.
8. Diphtheria Surveillance Unit, Rpt No. 6, Dec 1964.
Chapter 1, "Food-Service Principles," of the
Manual of Naval Preventive Medicine (NAVMED
P-5010-1), has been revised, and distribution is
anticipated in June 1965. It is recommended that
individual holders of the Manual of Naval Preventive
Medicine who have not sent in a change of address
within the last year submit a change of address form
to BUMED (Code 4561) in order to be assured
of receiving the new Chapter 1 .
AEROSPACE MEDICAL ASSOCIATION
The 36th Annual Meeting of the Aerospace Med-
ical Association will be held at the New York Hilton
Hotel, New York City, New York during the period
26 through 29 April 1965. A Military Section in
conjunction with this meeting will be held on the
above dates and each session will be at least two
hours in duration.
By authority of the Chief of Naval Personnel, one
retirement point may be credited to eligible Naval
Reserve Medical Corps officers in attendance. Offi-
cers are requested to register with the Commandant's
Representative in order that attendance may be re-
corded and reported.
BRONZE STAR MEDAL AWARDED TO
LT RICHARD R. SHULTZ
On 21 January 1965, LT Richard R. Shultz MC
USNR, was presented the Bronze Star Medal for
service as set forth in the following CITATION:
For meritorious achievement during the period
12 October 1963 to 1 July 1964 while serving with
Station Hospital, Headquarters Support Activity,
Saigon, Republic of Vietnam. In addition to his
regularly-assigned duties, LT Shultz, in his off-duty
time, carried out a program of providing medical
assistance to men of the Vietnamese Navy Coastal
Force and their dependents. He visited Junk Divi-
sion bases in remote, and, in many cases, Viet Cong
infested areas to provide what was often the first
professional medical treatment ever received by the
paramilitary junk crewmen and their families. Al-
though exposed to enemy gunfire on several occa-
sions in conducting these visits, he continued to carry
out his missions, winning the admiration and respect
of the Vietnamese by his courageous conduct under
fire. During his tour of duty, LT Shultz provided
sorely-needed medical assistance to over 3500 per-
sons, and initiated a program of regular medical
visits to remote Junk Division bases which has been
continued by the Vietnamese Navy. His leadership,
courage, and inspiring devotion to duty were in
keeping with the highest traditions of the United
States Naval Service.
S/Paul H. Nitze
Secretary of the Navy
PRIORITY ON SEWAGE DISPOSAL
Sewage disposal, often the last element consid-
ered, is getting priority in a move to attract devel-
opers to an area of northern Virginia.
On county-owned land near Dulles Airport, Fair-
fax County authorities are building four compact,
modified activated sludge sewage treatment plants
designed to meet the needs of more than 10,000
persons. — Public Health Reports 80(1): 10, Jan-
U.S. NAVY MEDICAL NEWS LETTER
PROCUREMENT, TRAINING, AND
ASSIGNMENT OF PHARMACY TECHNICIANS
CAPT C. V. Timberlake, Jr., MSC USN* and
LCDR Robert L. Smith MSC USN**.
"WANTED: Handpicked, career-minded, well-
motivated modern Petty Officers as candidates for
Thus possibly would read a want-ad, if we used
such a system, to procure our pharmacy school can-
didates. The criteria may appear too exacting and
idealistic but in this fantastic era of scientific ad-
vances and developments, particularly in the phar-
maceutical industry, we feel there is a definite need
for a more selective student to cope with the de-
mands and challenges of this parade of progress.
Not too many decades ago, the old Pharmacy and
Chemistry School at the Naval Hospital, Washing-
ton, D.C. turned out a select group of pharmacy
and chemistry technicians fairly well versed in both
sciences. They served not only in the pharmacies
of the major naval hospitals but were frequently
called upon to perform as toxicologists and chemical
researchers when the occasion arose. Those were the
days before our medical research and preventive med-
icine units. Those were also the days when the
medical officer had but a few potent selective agents
and the pharmacist spent a considerable portion of
his time compounding favorite "recipes" in the
hopes of conquering the profusion of incurable mala-
dies. Today, the pharmaceutical manufacturer is
producing these time-consuming medicaments in tai-
lor-made, ready-to-dispense form and the pharmacy
technician is no longer primarily a compounder but
more, a drug consultant.
With the products of modern pharmaceutical ad-
vances appearing en masse, the need for a highly
trained, well motivated pharmacy technician is be-
coming more and more acute. This accelerated pace
demands an academically trained man. We can no
longer afford to take a likely prospect into the phar-
* Assistant Staff Director, Professional Services, Bureau of Medi-
cine and Surgery, Washington. D.C.
** Pharmacy School Officer, U.S. Naval Hospital Corps School, San
macy as a striker and let him learn "on the job."
He is not exposed to, nor does he master the finer
points of the profession and eventually he will be
at a loss without them, conceivably to the embar-
rassment of the medical officer or the command.
Selecton of Candidates
The present criteria for procurement of candidates
for pharmacy school are: 1. volunteer, 2. high
school graduate or equivalent, 3. combined
GCT/ARI of 1 10, 4. sufficient obligated service (36
months), and 5. command recommendation for
training. We feel that at times tolerant interpretation
of items 3 and 5 have resulted in a number of stu-
dents with boderline qualifications.
The volunteer requirement presents a twofold
problem: (1) we are not getting a sufficient number
of volunteers, apparently due to lack of recruiting
at local levels, and (2) many of the candidates we
do obtain have invalid ulterior motives ranging from
additional shore-duty to escape from an undesirable
Waiver of the GCT/ARI requirement is by no
means to the student's advantage. He is usually
placed in a situation where he is at a disadvantage
from the very beginning. Academic records indicate
that this type of individual is a poor risk and will
eventually be dropped for scholastic failure.
Finally, item 5, the recommendation, many times,
appears to be given superficial consideration at best,
if not automatic; the intent being lost along the
It is felt that our pharmacy officers and senior
pharmacy technicians could greatly help alleviate
these problems, since they in turn would be the ones
to profit most by the finished product. These goals
can be achieved by vigorous and realistic recruit-
ment and personal interview.
When recruiting, keep in mind the service useful-
ness to be obtained from each candidate. Why look
for the bright young corpsman just out of basic
school who, although possibly having a degree of
higher education, still lacks naval experience? What
about the young HM3 or HM2 on the eve of re-en-
U.S. NAVY MEDICAL NEWS LETTER
listment or discharge? It is possible that the same
HM3 or HM2 who, having reenlisted, is now looking
for a specialty, since he has made up his mind to
make the Navy a career. We feel that we are over-
looking a great number of promising young corps-
men who could be recruited for pharmacy school
as an inducement for re-enlistment or beginning
a career as a hospital corps technician.
As a possible guideline for interview, it is sug-
gested that the candidate's educational background be
thoroughly explored. Particular emphasis should be
placed on chemistry and mathematics. The didactic
training is centered heavily around these two
sciences and 352 hours out of a total 672 are in
these two particular subjects. Many hard working,
well intentioned corpsmen have been assigned to this
school who are incapable of doing even the simplest
mathematical manipulation and appear to lack the
basic ability to approach problems logically. These
men, if graduated, would seriously jeopardize the
medical profession when called upon to calculate
the potent dosages of our modern drugs.
The courses in chemistry are designed to impart
a basic understanding of drug composition to the
student, so essential in the role as drug consultant.
There are undoubtedly a few well motivated men
who could satisfactorily complete the course, al-
though lacking in these prerequisites. Statistically,
however, they are rare indeed.
Needless to say, attributes of moral fiber and per-
sonal responsibility should be sought. To graduate
a student with questionable motives and demonstrat-
ed traits of moral irresponsibility (military and civil
infractions, marital experimentation, indebtedness
and alcoholism) certainly is hazardous in this pro-
fession and eventually would prove embarrassing to
It is felt that by recruitment and personal selec-
tion, every pharmacy officer and senior pharmacy
technician in the field could recommend at least two
candidates per year, thereby maintaining an ade-
quate influx of students and graduates.
A program is presently being considered in San
Diego whereby contact will be maintained with the
student after graduation. His department head will
be asked by periodic questionnaire to evaluate his
performance in the light of present day needs. The
results of these surveys obviously would aid the
school in its mission. Emphasis could be shifted,
broadened or adjusted as necessary to meet the de-
mands of field activities.
Ultimate Duty Assignments
It is economically essential that the pharmacy
technicians be utilized in their specialty upon grad-
uation. From the technician's standpoint, his utiliza-
tion in this field is vital for his morale and profes-
sional future. His training in pharmacy school
constitutes only a foundation upon which he must
build with learning and experience. Today's medi-
cine demands that he maintain daily contact with
technical advances in order to remain useful to the
The proper procurement, training, and assignment
of pharmacy technicians will directly influence the
ultimate recipient of their services — the patient;
without whom our profession would be quite un-
CHANGES IN ARMY PG COURSES
Navy participation in the course "Principles of
Military Dental Research," to be conducted at the
U.S. Army Institute of Dental Research, Walter
Reed Army Medical Center, Washington, D.C.,
10-14 May 1965, has been cancelled, due to space
limitations in classroom and in programmed field
This change supersedes the announcement in Med-
ical News Letter 44(8), 23 October 1964. — Train-
ing Branch, Professional Div., BuMed.
ANNUAL ANESTHESIOLOGY REVIEW
SESSION FOR THE ARMED SERVICES
Location: Wilford Hall, U. S. Air Force Hospital,
Lackland Air Force Base, Texas
Dates: 7 through 1 1 June 1965
This course is designed as a review for residents
who have completed their training in Anesthesiology
and desire to take the American Board of Anesthe-
siology Examination on or about 28 June 1965.
Requests should be forwarded in accordance with
BUMED INSTRUCTION 1520.8A at least 8 weeks
in advance of the convening date of the course. A
limited number of eligible officers may be provided
with travel orders to attend at Navy expense. Others
may be issued Authorization Orders by their Com-
manding Officers following confirmation by the Bu-
reau. — Training Branch, Professional Div., BuMed.
BRONZE STAR AWARDED TO LCOL
BRUCE S. OTT
Washington, D. C. (AFIP)— LCOL Bruce S. Ott,
Chief of the newly created Experimental Surgery
Branch of the Armed Forces Institute of Pathology,
U.S. NAVY MEDICAL NEWS LETTER
L-R: Brig Gen Joe M. Blumberg, Director of AFIP, Washington, D. C, presents
Bronze Star citation to LCOL Bruce S. Ott, Chief of the Institute's Experimental
Surgery Branch. Mrs. Ott and CAPT Bruce Smith, Deputy Director of the Institute,
watch the presentation. (From: Technical Liaison Office, AFIP)
has been awarded the Bronze Star for meritorious
service in Vietnam.
A grauduate of Michigan State University (DVM,
1946), LCOL Ott received the award for his out-
standing performance as senior veterinary advisor
to the Republic of Vietnam Armed Forces Veterin-
ary Service during 1964.
The Bronze Star and citation were presented by
Brig Gen. Joe M. Blumberg, Director of the Armed
Forces Institute of Pathology, in special ceremonies
attended by COL Stephen Asbill, Chief of the Army
Veterinary Corps; COL Wilson M. Osteen, Deputy
Assistant for Veterinary Services, Office of the Sur-
geon General; COL Robert C. Yager, Director of
the Division of Veterinary Medicine, Walter Reed
Army Institute of Research; and more than a score
of key AFIP personnel.
The citation accompanying the Bronze Star sta-
ted: "Through his untiring efforts and professional
ability, he consistently obtained outstanding results.
He was quick to grasp the implications of new prob-
lems with which he was faced as a result of the
ever changing situations inherent in a counterinsur-
gency operation and to find new ways and means
to solve those problems. The energetic application
of his extensive knowledge has materially contribut-
ed to the efforts of the United States Mission to
the Republic of Vietnam to assist that country in
ridding itself of the communist threat to its
A native of Allentown, Pa., LCOL Ott assumed
his new duties as head of the AFIP Experimental
Surgery Branch Jan. 21, 1965.
AID IN POISON IDENTIFICATION
An infrared spectrophotometer aids chemists at
the Florida State Board of Health in identifying poi-
sons, drugs, and narcotics. The instrument can
"name" any one of over 20,000 organic substances
in 10 minutes. — Public Health Reports 80(1): 10,
U.S. NAVY MEDICAL NEWS LETTER
DEPARTMENT OF THE NAVY
U. S. NAVAL MEDICAL SCHOOL
NATIONAL NAVAL MEDICAL CENTER
BETHESDA. MARYLAND 20014
PERMIT NO. I04S
POSTAGE AND FEES PAID
U.S. NAVY MEDICAL NEWS LETTER